HomeMy WebLinkAboutpermit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��/
-Em 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:
PROPOSED INPROVEMENT LOCATION
Address: .
Legal Description:
Property Tax ID#:�� �� V• 0309. p063 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION s 3
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
0WNER%1ESSEE CONTRACTOR
S
Name"Df I (r t?E,Fi'l Name:f)17,Y .
E,.
Address:5�6 2 14A 4P*-,i Company:
City: P,ellLz- State:LG Address: y-7 f ,.trG✓ �'/+wc� 04.E , -Si,- 227
Zip Code: Jq?� Z- Fax: 'City: to!`-S Luh<< j Stater
Phone No. 9 '77'7-- 3'39- a 1C(o6 Zip Code: 3L( `7 Y3 Fax:
E-Mail: Phone No •-? -7 2 - 9-77-)00 /
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.