HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��la' 5 Permit Number:
REGEIV�'7D AUG 121015
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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR�
Address: :ggAQ S Cc:AA)t:DP•
Lega;Desct ip bon: SN2oLL IJ jL IVI LL/t S (1&Jjo
Property Tax ID#: _Vaa 604-1Cep 0 S — b d� — � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFORMATION:
itio workto e e orme under this permit—check a app y:
_HVAC Gas Tank ❑Gas Piping u Shutle-I s VJir�uovvs/uoors
Electric ❑.Plumbing Sprinklers 1:1 Generator �Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: . . CON TRACiOR:
Name Name:740NAM 0. 004,146?
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City: tq fJ n Ln uc� �L State:_ Address: 633 NZ ffi X ZJ V W
Zi^r-de: 3yG.� Fax: City: cfy(zS Sr 6uci 1F— state:(.
Phone No. 96 1 joe 1515 Zip Code: 3�19 0,1 Fax:
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E-Mail: Phone No. Pi
Fill in fee sirup?e Tigre;Holder on e L paoe;if dMerent E-iviail: K vol-UiT C 04-) eAs S• / )s_7"
from the Owner listed above) State or County License: CACO��
If value of construction is$2500 or more,a RECORDED Not'ce of Conin:f ncernent is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MOR T GUAGE COMPANY: _Not Applicable
Name: Name:
Address: _ _— _ _ Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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Name: Name:
Address: Address:
City: City:
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';:::5�7:C::,:.`. `n i_�C.:nt�.`nn subicr_+structure
nylaws or andrCOVenantS that may or prohibit rohibit such
_ - restrictions 11 - "� -� - - - - - - - _,, _. _ .. •-" -- ,.._ . -..�, --�•- - , . . __. •�r a�;y re fictions which mayapply.
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L 11YARitae;i.±gG 0 0"UUNJEER: our fa;la. a i-O E e:.£.``:a a Notice f� � ,_`....._.•.• •
• 'L'. 3Y`ii: c:::. :::.,.:i cT:�y is§::E$in.your�ajii:6�aE-aiCe for
f1 pe improvements to your property.A Notice of Commencement rnijst be recorded and posted on the jobsite
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r�Sigr of wn r/L eJAg Signaf _ of Contractor/License olderf -�
STATE OF FLORIDA STATE OF FLORIDA `
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
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xi ,nally Known OR Prod- �`,*fv��t�ic)A Personally Known OR Pr /� c �5° I
f�inn of Irinntifratinrl..Pr^!II�CPCI iJ
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I Commission h5: q� �com' o�; ooa Corr::::: .. .._ �'-.�I 6 °g� its
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Revised 07/15/2 4�„ f eieee
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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