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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��n QCL •��3
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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: T I Lc ;ccs
FRQP,OSED Ii1/IP'ROVEIVIENT,LQCATI,ON
Address: _�IOS L�SSra fir• �- �( PI LrE�, I=L 3�(q$Z
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Legal Description: Lrd;ah �1 iv,- k9- - L-o'1 " :Lg
Property Tax ID#: 0Z'(11D • Uy I I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF U1/ORK
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CONSTRUCTION INFORMATION 'x kf
Additional work to be ertormed under this permit-cF ec all appy:
❑�-HVAC _Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
L`=1 Electric ❑_Plumbing ❑Sprinklers ❑Generator ❑ Roof L❑ Roof pitch
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Total Sq. Ft of Construction: SFt.of First Floor:
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Cost of Construction:$ /lLpo Utilities:)Sewer OSeptic Building Height:
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01NNER%LESSEE ,. `CONTRACTOR ,
Name_moo-y 14 Ifo% Name: C kcdr* QtOoert,GnA
Address: l�ctt� NE 197,J Tvt Company: 13c1lw-,J-k (--Iccte;` Co,l,panZ
City: Q Ic e e cls ob a G State:LL Address: 511 N W #167
;Zip Code: 3yci7 7- Fax: City: Por+ SI. Lvc i c Stater
Phone No. Zip Code: '�4 G V Fax: 172- 67-1 • ctl(.4
E-Mail: Phone No. Z7 Z. roZ1 -ct49q
Fill in fee simple Title Holder on next page(if different E-Mail: lcall�,t�h« , LI t-i rI'c rFJ whG;I_ co-%
from the Owner listed above) State or County License: CD:,130pq i z,?--
If
ZIf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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