HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEP?ED
D.ate- I Permit Number.AS nn L91 .I
= =.RECBuilding Permit ApplicationPlanning and DevelopmentServics -
Building and Code Reguia6on Division
2M Wirginia Avenue. Fort Pierce FL 34982
Phone: (7n) 40-2553 Fax: (7n) 4a lws -Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMEhfT LO.CATIQN .
Address: 1 M Lucia caun�
Legal Description-
Property Tax ID #: 13 0 r I I 1 � Owl - Q �d 173 Lot No.
Block No.
Site Plan Name:
:Project Name:
Setbacks Front 2 � - Right Side: r Left Side:
UHVAC U'j Gas Tank L jGas Piping u ,w 1U%.lJ 11-1 -- - -- - --
❑_ Electric 1._t Plumbing 0,jers. O.e., 0R00f
Total Sq. Ft of Construction- J_ _ SO. Ft. of First Floor. 0 11
on• it -700 Utilitles:�Sewer _Septic Building Weight:
Cost ofconstruction: - $ - .
Nae 1 C, I Name:
m
Adder: G Company-.
�rh►'-b V Address: _
Tip Code• Fax: �% CitY
Phone No. 1-72'Q lo-7 -to7/D ZipCode•c
E-Mail: Phone No.
Fill in fee simpleTitle Holder on next page (if different E MaJ
from the owner listed above) State or Cc
Notice of Gommenaerr is fe9u
if value, of construction is 5zbw or more, a RECORDED -
State �L
Fax: i •% a1" �{6ly/
r
DESIM p11GINEER: Not Applica a MORTGAGE COMPANY: - _ Not Applicable
Name: j.q )a,J C! a Name:
Address'�/N� '�1a,^ieN o v, Address:
Ct' , , S may; State:
Zip: 33 (o0q Phone:
0 4 - VAOs gyp; Phone:
FEE SIMPLE TITLE HOLDER: - - _ Not Applicable BONDING COMPANY: Not Applicable
Name. Name: -
�. Address: -
- - Ophone: -
Zip: Phone: Zip."
1 aertify thai no i vork or installation has commenced prior to the Issim a of a pera t�mit
St Lucje mre
akes no rep l�on that is A�ruteb WjUa�� o aowrerrarholtrestrictor
such
whidh a with arty Home Owners deed for arty moons wh'ch nay apphl-
structure. Please aon�dt wh..yaur Home Owners Awn and your
In cogdwaom of the granft of this requested peso t; l do herellipSm dW I wK in all respect& parorm the work
In a000rdani a with the approved phm the Haa & iBuNding Codes and St Lude County Amendments.
Theftw.I bw-ldtng permit applkations are woniptfrom undegft a flip conowwwY review: room additionr6
ry res, swimming pools, fences, wails, signs, saeearoomVvIld accessory uses to another non-rr3sidential use
WARNING . I OWNER: Your failure to Reconi a Notice of Goimmenoentent may resuit in 'wore twice for
improvements to your property. A Notice of Commencement must be recorded and fhostied on the jobsite
before the first inspection. If YOU intend -to obtain with lender or an attorney befbre
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CpmnjrssipnNp; =_° ;_ �ission # GG 2o7a mjssiprlNO, ,������,�,,,�,� KAR �. NIELSEN
���State of Florida -Notary Pubii
<= My Commission Expire a= Commission # GG 207484
2o22
June 12, 2022
Revised 07/1512014
ZONING
REVIEW
SUPFAVLSOR
REVIEW
PLANS
REVI
VEGETATION
REVIEW
SEATURTIF
REVIEW
COVE
REVIEWS -
FRONT
COUNTER
DATE
COMPLETE
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