HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE,INFO MUST BE COMPLETED FOR APPLICATION TO BE-
ACCEPTED
Dater s`-. 3 Permit Number:
Build.i .g Permit Application
P(arining and Development Services
Byi g and code Reguiation Division
2300 VlrginidAuenue,Fort Pierce FL 34sQ
Phone:(772)462 1553 Fax:(772),462-1578; Commercial _ Residential
PERMIT APPLICATION FaR:. To.Select from dropbox, click arrow at;the end of line
PRQPOSE3 NIPR(3VEMENT LOCATION �r '` `
Address S/
Legal Description,:
Pro
perty Taxi D 4: A f�" �.H oco Lot`N'o:
Site Plan Name- Block-No _
Project Name:-.
Setbacks' Front Back:. Right.Side: Left Side.
D► fAILED bSCRIPTlQNaFWQRKAw
re
u � � '
5&
Fj
?NSTRi1 IUB N' QRNiATIOfV � 4= .
Additional wor to g Lertormed un .er.t.is permit—,check--a at appy 4
F1H1/AC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors.
Q, lettric QVIumbing []Sprinklers 1:1 Generator ORof Roofpitch,
Total'Sq.'Ft of Construction: Sq. Ft.of First Floor:
T _
Cost of Construction.$-.
Utdrties . Sewer Septic Building'Height:.
CB}WN [if1ESEE '. "'> ONTf2AGTC}R. .
Name err 4xpjtej •k. Name: O G;tia< a
:,Address; S' bti t) -17 c-i Company: AYc?P1 e� 801 �0s T.
City,_lMM State: l Address: 2,!93S tV,.InI=
't
Zip-Code __ Fax:acs 7 f y- 3 yr3h: ci
.33,1 ty:_Aelia State, Fl; .
Phone No S'- '-' X2.5 v Zip Code: Fax: _796-48L 9235—
E Mail; U�L10e pet 47o( �`�C earCk el:con, Phone.Na.� �'�cit' -7-15
Fill in fee simple.Title Holder an next page.(if different. E-Mail:
fromahe OWrter fisted- abov State or County L' ense. 1-4/77.
- `l
IfVaIU DED'Notice of'.commenc rp��4
JOSiEtC�ENCO , , JOSir GENCO
Notuy Milt-:Stab o1 Fl4rlds y_. Notary Public-Statu at fiorldb
. 3
My otnm Expires Nud 13, MY Comm;Eipirti Nov 13,902
'.°` Bontledthrough,NdllanalNoTaryAssn �'' i0 641141edtInug.., Hdnu:Pl myAm.