HomeMy WebLinkAboutBuilding Permit Application ALL APPLI E 1 M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Permit Number:
0
Building Permit Application
Planning and Development Services
Building and Code,Regulation Division
2300 Virginia Avenue,Fort Pierce F134982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT yLOCQTION
Address:
Legal Description: �Q Q to t S h (,c- Ic e' 'moi r &-,c& l W so'
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Property Tax ID#: 13 6 Lot No.
Site Plan Name: � &w'✓\ S ( (�eS tY Wei Block No.
Project Name:
Setbacks Front Back: Right Side:: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTLON,INFO_ RMATION -
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Additional work toe nertormed under this permit-check all tha^appy:
F1HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric El Plumbing Sprinklers 0 Generator D Roof
Total Sq.Ft of Construction: - Sq.Ft.of First Floor:
c/
Cost of Construction:$ l U C� Utilities: _Sewer Septic Building Height:
OWNER/LESSEE u. CONTRACTOR
Name C Name c¢ to C
Address: Company: Z
City: State:_(✓ Address: C T13 E cfce n l--
Zip Code: Fax: A114 City: F f f ayc- State:
Phone No. --�/5� Zip Code:r3 W 6';'- Fax:
�
E-Mail: f 14 Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: ce
from the Owner listed above) State or Coun icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN lAW INFORM�kION:
DESIGN]WENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address
Oty State: CR)r. She'
Zip: Phone: Zip: Phone:
FEE SIMPLUETM HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: ;= Name:
Address: Addresx
Phone: Z10.. Phone: -
I certify that no work or installation has commenced priorto the Ismance of a permit
S•Lucie Gu�makes no representation that is granting a permit will authorize the�holderto build the svb'ectst mcbire
which la in co d.with applicable Home Garners Action rules.bylaws or coli]co rms that rrray restrict or prohibit such
strvdur+e•Please consrdt w yon•Home Owners AssocsAion and remew your deed for arty restrictions which nay apph►•.
incaution of the granting ofWa requested perms 1 do hereby agree that i will,in all respects„perform the work
in awwdaace with the appnoeed pians,the Alorida BdI ft Codes acrd St.tutLeCoemW Aiamdnmeft
-nie following building permit applications are exempt from undergoipg a full concurrency r+ewew:room adder,
accessory structures,swimming pools,fiances,wags,srgris,screen rooms and accessory uses to another nowfesidenW use
WARNING TO OWNER:Yourfailure to Record a Notice ofCmumazement may r+esWt in your paying twice f or
improvements to your properly-A No6oe of Commenoemertt must be r�eoorded and posted on the jobsite .
m before file first inspection.tf you intend to obtain financing,oonsuft with lender or an attorney before
coin work or recordin our N 'ae of Commen'oem ,
_Stene of owner/Lessee/Agent Stpattire of cDnbactorjLkense Holder '
SrATE OF FLORIDA -- r STATE OF FLORIDA
COUNTY OFThe hlstrl�t C1NTY OF Q-
was acknumledwd Yefore we The instru ent was adu�owfedged before me
tl*; of 20 L Ute daVof 20 bio
( of person ) _ ( me of person admowledgirrg)
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(Srgnawre of Public-state of Fldrida -
of V3ry PubFly l
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' • w' My Comm.Ex (lip eS May 27,2019 '., srAires 730
Commission o:��°:�, throng Notary Assn. COfnnlisSlon NO. �e� ugh May 27,2019
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NationaI PdOtaW s sn..
Revised 0711512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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