HomeMy WebLinkAboutPermit app. Nacy Jervay--Deliz-1ALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I 1 g I ')Lo I � Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 f.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential L,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 5) Lf 3 Ca,n(n YLLO io_zk = C
Legal Description: ��( Lt 1-j (G 3 (a(�
Property Tax ID #: `( 00C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Aaamonai worK to De ertormeci
HVAC f Gas Tank
F]Electric LYJ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Tnis perms -- cneck all mat appy:
❑Gas Piping Q _ Shutters Windows/Doors
Sprinklers [i Generator 0 Roof Roof pitch
Name 1VXyL- .moi
Address: "l i -i 3 U CA—awnAl, �.G f4x0
S Ft. of First Floor:
Utilities: 11Sewer F]Septic Building Height:
City: Pc -1.-t` %1Lr1_" ut'&, e' State:
Zip Code: '7) Li'q Fax: _
Phone No. -71,_�) 3_31G - 611 S/l
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: 14 14 + i..,,y,
Address: q�0 1 g t4_, • �5L}
City: vo-Lo ' ��oLax State: iZo
Zip Code: "�> --q (� .9' Fax: 77�)-_770 - q656
Phone No. ' 7 7 3l�
E -Mail: 414-0 ZN ifs -ho w° la��( GOU,41 JV1="
State or County License: C,- C_ 0Ll �5�'' .D-73
11 VOIUC UI w11x1 Uld1Ul1 is ;oc3uu or more, a KtLUKUtu notice of commencement is required.