HomeMy WebLinkAboutBuilding Permit Application "11 cel- oZ-
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:=& Tj 51�5I 15 Permit Number: ` SOS -6 a 13
RECEIVED MAY 15 =
Building Permit Application
Planning and Development Services '
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: "15 1� S L1 !Q �-
Legal Description:
Property Tax I D#: 3 y b3-S d 2_- P pop) - ndni - L Lot No.
Site Plan Name: Block No.
Project Name: E M z9,Io!L Sl^dD P
Setbacks Front Back: Right Side: Left Side:
ti LL3 3/4 SLI.. 4 0 til 4Q�L
Additional work to be performed under t ispermit-check all appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric Plumbing ❑Sprinklers Generator ❑ Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 100 d Utilities: _Sewer®Septic Building Height:
Name S�. Lu C' - - Name: rte; 11 i FCi-or)C do
Address: L 9.5 Qpy0 Company:l� CoN �c ILy�G(tS
City: N 01-41,. eo-cit State:�J Address:q0%'N S S 1
Zip Code: %4Z.13 r? Fax: City: ��, �l e / I- e State:_JQ,
Phone No.`7 7 1 - FW - Cl 7`j� Zip Code: 3 L(01 Fax: �7�72
E-Mail: Phone No. �� - S�'S'�c7 1 [�
Fill in fee simple Title Holder on next page(if different E-Mail: 41,1 rooL,^ A--CinrSet/s p J� .N
C 1. -
from the Owner listed above) State or County License: /C'2,ezu
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
05/15/2015 12:35PM 7725959191 ACS ROOTER ONE PAGE 01/01
Not APP ca MORTGAGE 'OMPANY: Not ApplIcable
Name: Name:
Address: Address- State.
City- City:
FEE%MnE TMIC HMER; Not Applicable BONDING CC V-;A—W'�-, ___Not Applicable
Name: Name:
Address; Address-
St.Lude Coun makes no rep nt isgranqn� =ft will atftarint I fig.!V-mlt holrel to build the pubji-a I re
Which is In TRIct with any atlZOWN'90 fe wl A on rules,bylaws or art:, iverianut-,that rr",r%trict or p410- Tch
structure.P ease consult WItKTOUf HOMe hners ation and rrAikw your d,-Pd**) SAV rf-$XAv tiOnS Whit MOYSPOY.
In considerdion of the grantingof this requested permit I do hereby agree that i wi 1.1 all rei�iov.s,perform the work
in arwrdanrae with the approved plans,the Florida suildIng Codes and St Limit,Cour v �merldlnents.
The following building permit applications are exempt from undergoing a full conrair,t it ty review- oom additions,
accessory sructurgs,swimming pools,fences,walls,signs,screen room and aicfow--v isas to ancither non-rmidantlal use
WARNING To OWNER,.Your fWlure W Rowrd a Nodee of Commmeement r ly result In your Paong twice fQr
improvements to your property.A Notice of CbrnmenceMent must be i P,t orded and posted on the jobsite
beftire the first inspectlot.if you Intend to obtain financing,consult wi I I-, londer-tir an attomey bef6re
corm -r Ina your Notice of COMMenCeMent.
4 er
COUNTY OF JCAzt-L'e COUNWOF:
-rho for oing instrument was*ftmwledged Were me The f6wing Inran ri-ritvas acknvMedged before me
(Sianvturq of N6ti3ry Pubtle-State of Merida y;Slgvnla ere oINv;.i;,4-,ubli,--Si ate of Ploride)
Personally Known_��OR Produced Identification Personally Known rift eraduWA ld"IPSgion
awe
Revised 07115/2014
REVIEWS FRONT ZONING SUPWISOR PLANS VEG- t,,TICN SEA TUR11E MANGROVE
DATE
COMPLETE