HomeMy WebLinkAboutScan_20170314MLL MrrL11,Htftt !INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Appffcati®n
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 arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:_
Legal Description:
Property Tax ID #:
Site Plan Name:
Lot No.
Project Name:
Block No.
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
�OSAA 11 20 C et 1/0 + (,crl�- /
CONSTRUCTION INFORMATION:
Aclaitional work to 5e e orme un permitappy:
OHVAC
G Tank FIGas Pipmg
_ Shutters
a Windows/Doors
11 Electric _Plumbing Sprinklers
❑ Genera for
❑Roof
_
Total Sq. Ft of Construction:
S. Ft. of First Floor:
Cost of Construction: $ SSj0 � Utilities:iSewer R Septic
Building Height:
OW N ERAESSEE:
Name//1%Q�j"en LOG
Address:
City: State: _
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: _T,f,Dh TUI J_V
Company: (�'ne-, S �tsri16�� t>e(�1C S 7--n c_
Address: j20a SE $on.
City:7brt st, I_Li6tt State: L
Zip Code: 3H{9Sz Fax: 122- 335^a��o
Phone No. '722- 3;?7- 3GS-Z,
E -Mail: Gene5is`{ 1vMko1 SecU1c rh �tw
State or County License: G vA 2 b
If value of construction 1s $2500 or more, a RECORDED notice of Commencement is required.