HomeMy WebLinkAboutBuilding Permit Application ALL.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED u
Date:CPe it Number:
RECEIN17D JUN`2 5 201
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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 ar,ow at the end of line @�-
PRO POSED'IMPROVEMENT LOCATION:
Address: 02 rf /eeWe-e.&r 91A r-e- Io s L 3 Y 1 S"-2
Legal Description:
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Property Tax ID#: J yP2'eo - 7 0,7 D O 74 - Q p 0 - Lot No.—i--41-
Site
o. i-4Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Le t Side:
DETAILED DESCRIPTION OF WORK.:
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CONSTRUCTION INFORMATION: .
Additional work toe e rme un ert is perms -checka appIV:
HVAC Ei Gas Tank 7Gas Piping _Shutt ers L_]Windows/Doors
Electric J Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: SFt.of Fir Floor.
Cost of Construction:$ Ssr O. wo Utilities: Sewer _Septic Building Height:
OWNERAESSEE: CONTRA OR:
Name_ Name: c,s ev
Address: i8 /3 r- iqk vMa 60 Company:
City. Y:�71-e-O StateeVZ- Address: f d o2 Sd Ve l
Zip Code: Q 8 0 0 Fax: City: 1 L State: �-
Phone No. .6 - . 733 S 6 Zip Code: 3 Y cl-s-� Fax: 33.r 42-26 1 o
E-Mail: Phone No. 3 3 7 3 4�a
Fill in fee simple Title Holder on next page(if different E-Mail: e1�J I'�k�. �. 1�`+�ir�►
from the Owner listed above) State or COL my License: CF C 3
If value of construction is$2500 or more,a RECORDED Notice of Commenceme it is required.
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aJPR BM ENTAL OONSTRIJCRON LIEN LAW-IN ATI
DESIGNE=R1 EMGINEER Not Applicable M ORTG kGEOOMPANY Not Applicable
Name: Name:
Address: Address
Oty: gate: City: gate:
Zip: Phone: Zip: Phone:
FEE SM PLE TITLE HOLDER Not Applicable BON DIN3300 M PANY Not Applicable
Name: Name:
Address. Address`
City: City
Zlp: Phone, Zip: Phone:
Icertifythatnoworkorinstallationhascommencedpriortothe issuanceof a permit.
,q Ludo Countyy,makesno representation that is granting apermit will author ze the permit holder to build thesubject structure
whidl sin conflict with any applicable Home WersAssopation rules,bylaw or and covenantsth%may restrict or prohibit such
structure_Aconsult with your Home OwnersAssociation and review yout deed for any restrictionswNch may appl .
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I n consideration of t he granting of this requeded permit,I do hereby agree t h; I will,in all respectss perform the work
in accordance with the approved plans,the RorideBuilding Codesand Et.Luci (buntyAmendments.
The following building permit applications are exempt from undergoing a full c oncurrency review.room additions,
acoessory structures,swimming pools,fenoes,walls,signs,screen rooms and g ocessory uses to another non-residential use
WARNIINGTO OWNER Your failure to Pacord a Notice of Commen ment may result in your paying twice for
improvementsto your property.A Notice of Commencement mut be recorded and posted on thejobslte
before the first inspection. If you intend to obtain financing,cons ilt with lender or an attorney before
commencing work or recc)rdin-q your Notice of Commencement.
gnat ure of CWnerl Age Lessee ure Dnolder
I
STATEOF FL.ORI DV STATE OF FLORI DA.
COUNTY OF v c i C COUNTY F_ 'W
Thefor Ing instrument esadmowledged b ore me the fpr in instrument acknowledged b fore me
this I day of .. 20 3 by this _d of__ cl"n 2D y
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(Name of r n ledgin (Nameo p sin n 4ging
grrature t Pu i of Rorida) Sgnatu a of Publirida)
FL-rsonal „ �, erg ion Person f i cation
Type of 1 : t owe�e i7 Type 01 _iR%�S��e�i-tr1=
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ti,w. EXPAEs May 21,2 EXPIRES May 2t,2019
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Revised 07/15/2014
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DATE
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INITIALS
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