HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % -/&
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
'ERMIT APPLICATION FOR:
kddress:
-egal Description:
Permit Number:
Building Permit Application
Commercial_ Residential
77/1 lti/A&
�7�J�" /�i� Lot No._—
Property Tax ID #: Block No.
Site Plan Name'
Project Name:
Front
Back' Right Side: Left Side.
Mechanical
Electric
Gas Tank
— Plumbing
Total Sq. Ft of Construction: /
Cost of Construction:
Name _ C/ �� e- 4 sCoZT�
W
Gas Piping
Sprinklers
----------------
Shutters
Generator
Sq. Ft. of First Floor: —
Utilities: _Sewer Septic
Address: 7
City: 1 . State:
Zip Code:
Phone No. 7%d 3 i –
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
iv of construction Is
Windows/Doors
Roof
Building Height:
Name: CurtlS S vnrnon S
�T� Ais
Company: �,
Address: Ike l5 v
�
State: EL
city: Portz ST
Zip Code: Fax:
Phone No. 1 ' 3 �3 2
E -Mail: C t r ° l .
IState
or County License: 2 C
2SeC'or more, a RECORDED Notice of Commencement is required.
75-00
Name:
Address: State:
City*
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
city
Zip:
Phone:
ip:
MORTGAGE COMPANY:
Not Applicable
Name:
Address: State:
city. Phone:
Zlp: Applicable
BONDING COMPANY: Not
Name:
Address:
C'Ity:
Zip: �—Phone:
CONTRACTOR AFFIDI Application is hereby made to obtain a permit to do the work and installation as indicated.
DWNER/ prior to the issuance of a Permit.
I certify that no work or installation has commenced p restrict or prohibit such
St. Luae Coun makes no representation that is granting a permit will abylaows or and covenants thatt mayd the subject structure
�y applicable Home Owners Association rules' anyrestrictions which may apply.
which is in conflict with any app perform the work
structure. Please consult with your Home Owners association and reviewe that I willinall respects, P
In consideration of the granting of this requested permit, I do hereby agree ' amendments.
in accordance with the approved plans, the Florida Build't undergoing a full Codes and St. concur review: room additions,
The following building permit applications are exempt fromuses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory resu� in your paying twice for
WARNING TO OWNER: Your failure to Record a Notice of Commencement may before
t must
imptain rovements to your property. A Notice of Comm financing,enconsultbwith lender or an attorneythe jobsite
before the first inspection. If you intend
t ce of Commenceent.
commencin work or recor ' n141
Signature of Contractor License Holder
Signature of Owner/ Agent/ LessrC
STATE OF FLORIDA , 9 Ccs
COUNTY OF
The forgoing instrument was acknowled0ged by re me
this day of _��
l�0 S
(Name of person acknowledging)
(Signature of Notary Publ)C' State, of Florida )
Personally Known__,) OR Produced Identification
Type of Identification Produced B CHRISTIN
i013 # EE 85'
STATE OF FLORIDA n��C / {-
COUNTY OF J/X
The forgoing instru t, was acknowledged before me
20 by
this day of
Y COMMISS -
Commission No.alp ZC'� # EXPIRES: April 4, 2017
m of e�
M" eon* 1Mu 9udpet Notary S*m
FRONT ZONING SUPERVISOR
REVIEWS REVIEW
COUNTER REVIEW
DATE
L l p /S
(Name of person acknowledging)
(Signature of Notary Pub ic- Stat Florida )
Personally Known OR Produced Identification
Type of Identification Produced H
* MY COMMISSION # EE 859284
aWPIRES: April 4, 2017
4CommiSsion No.Rordod?hruBudge Notary Serwes
SEA TURTLE MANGROVE
PLANS VEGETATION REVIEW REVIEW
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