HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE/INFO MUST BE COMPLETED FOR APPLICATION TO BE
ACCEPTED
Date: Number: I\Jy��® 40
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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 Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click carrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Sir-
Legal Description:
Property Tax I D#: 3 y/ -S`yo D o2,2 6 ao - Lot No. P2
Site Plan Name: Block No. 5�-O
Project Name: z7ru.v e rW--c/
Setbacks Front Back: Right Side: L eft Side:
DETAILED DESCRIPTION OF WORK:
Alesc/e2.
[CONSTRUCTION INFORMATION:
Additional work toOrme under tis permit-c ec a appy:
HVAC OGas Tank ❑Gas Piping _Shu tters Windows/Doors
Electric Plumbing Sprinklers Gen rator Roof
Total Sq. Ft of Construction: S Ft.of Fir;t Floor:
Cost of Construction:$ ��d.0�7 utilities: Sewe Septic Building Height:
OWNER.//LESSEE: CONTRACTOR:!-
Name 6y/ IL /,�/aws l..,SK a ( Name: U,S e/// f SLG
Address: /6 `/ se.- /jr,5,�,� 1r�t r A?Ap7 Company: G'&e e-f Gs-.w00SG�vice
City: State:_,Z'l Address: Ifoa -CA-, Q �5.•�2
Zip Code: 3 ySS.L Fax: City: State:
Phone No. Zip Code: 3 V f X-4 Fax: 3 I-rae Sib
E-Mail: Phone No, 3 3 68.2
Fill in fee simple Title Holder on next page(if different E-Mail: Q rim �Lc.•.+�•. S2rus ..swRi.
from the Owner listed above) State or Co my License: e JCC l Yat S /2) 3
If value of construction is$2500 or more,a RECORDED Notice of Commencem nt is required.
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PRBAENTAL OONSMCTIONIJENLAWINFORM A-PON:
DEEIGNERENGINEER Not Applicable M0RTGkGE00MPANY- Not Applicable
Name: Name--
Address: Address
Qty: Nate:_ (3t)r._ State:
zp: Phone. Zip:_ Phone:
FEESM PLETITLE HOLDER Not Applicable BOND! OOM PANY: Not Applicable
Name: Name.
Address: Address:
City: City._
Zip: Phone- Zp: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
a.Lucie Cbun uthod thel nit holder to build the subject structure
"in"
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which is Nor%makes no representation that is granting a permit vAll a !bit such
elict with any a -,byi Roovenants Jth?t may,restrict rt or prohibit
.applicable Hog OwfiersAsgpdation rules
structure. consult with your l-lome vnersAssociation and review you pr any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree th Iwill,in all respects,perform thework
in accordance with the approved plans,theFlorida Building(bdesand a.Lud (bunty Amendments.
Thefollowing building permit applications are exempt from undergoing a full ncurrency review:room additions,
u
accessory structures,swimming pools,fences,walls,signs,screen rooms and ry uses to another non-resident lei use
WARNINGTU OWNER Your falureto Record a Notice of Cbmmen ment may result in your payli nq twicefor
imf rovernentsto your property.A Notice of Commencement mu, be recorded and posted on the j obsite
before the first inspection. If you intend to obtain financing,cons It with lender or an attorney before
commencinci work or recordinci vour Notice of Commencement.
%nature of Ownerl Agent/Lessee kgg- u�reof(bnfrartor/Ucensel-bider-,---
STATE OF R-10R.Q�_1 STATE OF FLORIDA, I
CX)UN7YOF COUNTYOF -Sl- W
The forgoing instrurne t was acknowledged Wore me The for gor ri�instrument was adamledged before me
this4�1,day of 20 15 by this _T
da i of M oLc/ 215 by
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(Name of person fi*nbwIe4jng) tct 1 j (Name of pe son a&nowledging)
(Elgriature of Notary PIQUION (SgnatureoNotary Public,Rate lFlorida)
Personal! Mown dd l jgflorlda Personally K own. ✓ ORP ification—
in
Type of Identification 17 Type ofWW
tT�wo ar,
Public soI
Florida
(brnfssion No. (Sal) 0=ml
FF 4772
21317-
qty comm.expires Ap•
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Revised 07/15/2014
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