HomeMy WebLinkAboutCCF12192017_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /0� V Y 17 Permit Number:
on
nuiming rermit 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
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
YKUNOSED IMPKUVEMEN I LUCAI ION:
Address:
Legal Description:
Property Tax ID #: J`t2J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED DESCKIP I ION OF WOKK:
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CONSTRUCTION INFORMATION:
dai"oonai`wor to e ermeun er this permitc—ek phuptyt
�WindowsJDoarsHVAC �GasTank
[:]Gas Piping ers
11 Electric El Plumbing Sprinklers ElGenerator F1 Roof Roof pitch
Total Sq. Ft of Construction: / Sq. Ft. of First Floor:
f0 Building Height:
Cost of Construction: $ y Utilities: SewerF]Septic
OWNER/LESSEE: CONTRACTOR:
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Name .lei 4k� e La24z_'_1 JY/n&6 Name:U rL T l < NF16ll-v\cccr,
Address: 9 l Z/1�ic� 4�/'� Company: Cum-roiyt Jli S P4Vl`; i n c,
City: State: �% Address: S E��; l .i dG -,? �� r ee r1
Zip Code: % l��' Fax: City: F�(, 2T St . C v c (t,_ State:
Phone No. Zip Code: Z'+g5Z- Fax: 7`L2-
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E -Mail: Phone No. 111
Fill in fee simple Title Holder on next page { if different E -Mail: C u S t c1 I r S y -r- lc o l C C• 0ti I
from the Owner listed above) State or County License: c c)
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_. __.___-._-_..._. __ ........-__.._J
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
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SUPPLEMEN IAL C;UNS I RUC IION LIEN LAW INFUliMAI ION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone: '
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
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