HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3� 1 Permit Number: V103
RECEIVED MAR 297017
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:
Address: 16 � F+ 1'i`�w-Z
Legal Description:
Property Tax ID#: '�1/ a� " �{l�s— 06 a3 ` 000 — Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
MI-0-01
314.'r4AC )06A- 4-o !s--6A-ItII ri'str i- e otod
rife\.J1,5 _ - cevire' I
Additional work to be performed un er t is permit check all tat appy:
_Mechanical _Gas Tank _Gas'Piping _Shutters d _Windi}ws/Doors-
Y Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: )3 _. . _ _ Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
a
Name 'eUI( .Name:
Address: �. (, "Company: w er vZ he
City: State: Address: D
Zip Code: 7�a c(�t_7 Fax: City: ,Rea-e-_ State: R
Phone No. Zip Code: 3 Y� ] Fax: Y�6—d 96
E-Mail: Phone No. 65-00
Fill in fee simple Title Holder on next page(if different E-Mail: W II&7_ I V1 C_ d WI
from the Owner listed above) State or County License: C—L 13-60
If value of construction is 2500 or more,a RECORDED Notice,of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made;