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PLQrrj1nIr Number;
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Planning and aeWIOPI"ent SerVices
Building and Code Regulation Division
Moo thrginin Avenue, Fart Pierce R 34.9$2
Phone. (772) 462-3553 Fag: Q772) 4jj2_357 ��1����G➢ � _ . � Residential
PERMIT APPLICATION FOR: �
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PROPOSED IMPROVEMENT LOCATION'.
Address: �7 C". _ C
Legal Description:
Property Tae ID #: 5 d �07 - Ljo ss - 060 - -
Lot Na.
Site Plan Name: Block No.
Project Name:
Setbacla FronL. Baric -Right Side: Left Side:
DETAILED DESCRIPTION OF WORK-.
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CONSTRUMON INFORMATION:
appy.
Auditional work r unclerthis permit- c ec aM-Shutters
HVAC Gas Tank bas Li
Piping Windows/Doors
Electric Plumbing 11prinklers 11 Generator LLtJ Roof
Total Sq. Pt of Construction: Sqji. of First Floor:
C 3 �
SL of Construction: $ Utilities Seeder Septic Building Height:
WHERAESSEEo
CONTRACTOR:
Name `
Dame• t--=� 11
Address:" d Le
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company: �_-t�c� ', �- L r
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City: e,as Stater
Address: 7 ��i�S „-•
Zip Code: JF
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City: . r,r •�
Phone No._2 a--
ZIP Code: `' Fax: 1P !�- / 1.2 '7
E -Mail:
PUB
Phone No. cl ErS
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E -Mail: � c Con eLi.%
tho OrsRwP listed aboawQ
State or County License: AE t B'l 3 6 ,rf- [
Iff Vdus $2150 @r h1fl5'@, T Roicauanzo �,9 �6�r� of Commencement Is reag dmd.