HomeMy WebLinkAboutCCF03162018_0003ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,�--I �D " 1 p Permit Number:
ouiiairig Vermix Appilicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 452-1553 Fax: (772) 462-2578 Commercial Residential
i
PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
i
PROPOSED IMPROVEMENI LUCAIION: s
Address: '7o2(5_5 PQ11Y1 0�2
Legal Description:
Property Tax ID #: .32Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED OtSCKIN I ION OF WORK:
See( p c Dom"
CONSTRUCTION INFORMATION:
darn na wor fo a er ormed under this permit — deck a appy:
aHVAC �GasTank [:]Gas
Piping Shutters Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5 Utilities: ElSewerFISeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
-- ---i
Name �' Name: CUtnzl <.- ,Si-lrllb•z�c�� j
Charles -�Q..� i
AddrePrCompany: C u r To rpt
_
City: �%��COC�CiStater L, Address: i 4'15 S E �A 11 d reeo1 �� ✓ I
Zip Code; T :3 i 9E& Fax: City: PC) P 9t, L. u c (e_ State: r
tt
J-35 1 I %r
Phone No. ��a � ���8 — E(2 -75 Zip Code: �`(-q5�. Fax: rfr�- '`
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail: C 4 .s t C.
from the Owner listed above) State or County License:
ff value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ISH
Owe
m
3
SUPPLEM EN i AL CONS I RUC; I ION LIEN LAW I NFORMA I ION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
i
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
ISH
Owe
m
3