HomeMy WebLinkAboutWH APPL 4.13.2017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 a�
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: 100 QQ.'(i it ccf �L Y')
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Legal Description: ¢ t ao r,
Property Tax ID #: '�7�%�� �� .> Lot No. S
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
( DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to a er orme under this permit— check a that appy:
HVAC M Gas Tank ❑Gas Piping Shutters Windows/Doors
EJ Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .7 Utilities: Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address_ 00 l' UJ 22C l- V -\Company:
City: Ti �'—� State: R_
Zip Code. Z Fax-
Phone No. 77;2 — 7? — U±. 3
Address:
City: 2Q = State-
Zip Code: I C/0 Fax: _
Phone No. - �%%7 C%
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: { 1 1 C 00 co"4
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State or County License:C
IT value or construction is ,>t5uu or more, a RECORDED Notice of Commencement is required.