HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - FIRE DEPARTMENT4
.jP ICE USE ONLY: �1 � s
[)ATE FILED: c PERMIT NUMBER:
PLAN REV L• W FEE: f' RECEIPT NO.: -
rnNr.TTRRENCY FEE:
RECEIPT NO.: CERT. CAP. NO.: _
ALL INFO MUST BE COMPLETE & PILLED IN TO BE ACUk4r 1 JAL
PLANK VELOPMENT SERVICES DEPARTMENT
& CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772 462:�4
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IG PERMIT
CERTIFI5 �
oAAPACITY/ZONING COMPLIANCE, SC4WN
�®�E `I< INS T T�®Iv y �-zi `►
>Q�Y
= St Lucie
1, LOCATION/SITEA� ESS:
2. PROJECT NAME: G�i SITE PLAN NAME: Oc�
3. PROPERTY TAX ID #:,
4. LE L DESCRIPTION (attach extra sheets if necess4ry) •
5, PLAT BOOK
6. PAGE NO. 7. BLOCK NO, 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
'10, COMPLETE D , SCRIPT ON OF CONSTRUCTION PROJECT OR WORKC I�ITY
i�
FT SIDE:
11. SETBACKS (ACTUAL) FRONT^. �'r BACK: --RIGHT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes) rNTERiOR RENOVATION
[ ] NEW CONSTRUCTION [ J EXPANSION/ADDITION [ I INDUSTRIAL
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: C
TION: 6 4/1/10-417, FT I st FLOOR:
14. SQ. FT OF CONSTRUC
16. VALUE OF CONSTRUCTION: � 4;7,4
There of construction is used to determine the amount of perms assessed. St. Lucie County reserves the right to question and/or .modify the indicated
valueeof construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities, if rho valuo.is $2500 or more, a
RECORDED Notice ofCommaiccmcnt mustbc submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6125109
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OWNER INFORMATION 17 �... � , /� L)�
NAME:
CITY: V t`/!/
PHONE (DAYTIME): �D "(` GB Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG. CERT #: , v
BUSINESS NAME:
QUALIFIERS N�j1ME:
LUCIE COUNTY CERT #: i 1 --� � ('P
CITY: ��l/GIiYc L ��L�_ STATE: ZIP:
PHONE (DAYTIME): 7 �� FAX NO.Emai1:
ARCI-EVENGIINEER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (—
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it well be ov tided and returned to you by mail.
3
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Property Valuation ( Property Alert Edit Permit I search Permit I Review I InspectionPermit Fee/Payment Misc Fee Contractor ( Reports ( Maint I Fiscal I Post Date Maint I ERD
Submit Query :PoVALUATION Permit#
'Enter Permit M. (Press ENTER) 1308-0371 { 1308-0371
TENANT BUILD -OUT CONSISTING OF 110 L.F. OF PARTITION WALLS IN UNIT #1(SI
i Master Permit#: 0 Job Description: A) - NO PLUMBING OR MECHANICAL — OCCUPANCY CLASSIFICATION IS GROUP B,
Date Issued: 0 Issued By: Date Finaled: 0 Finaled By:
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