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ALL APPLI , L INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 4 ` Permit Number: iNn 5"
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REC VED
Buildipg Permit App liCation MAY 0 2018
Planning an Development Services .i
Building and ode Regulation Division
ST.
Ludo cgyn y P fitting
2300 Virginl Avenue, Fore Pierce FL 34982
Phone: (77� 462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT A PLICATION FOR: p
To Select�from dro box, click arrow at the end of line
Address:
Legal Descrip on:
Property Tax #: 3U25- -7103" ( )U 000—q
L No,
Site Plan Na BI ck No.
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Project Name. ��� l
Setbacks F nt Back:__ �Aight Side: Left Side:
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tlo w o e er orme un er is permit—c ec a appy:
HVAC Gas Tank 013w Piping _Shutters O Windows/o ors
Electric U Plumbing OSprinklers Generator Roof
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Total Sq. Ft of onstruction: 5 .Ft, of First Floor,
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Cost of Constr ction: $ H'V'V15. 00 T Utilitles: Sewer Septic Building Heig ;
Name Name:
Address: Company:
city: l StaI e:==-f Address: i
Zip Code: I ( Fax: Clty:.P()y+ 'Eyr line i tatQ:F�
Phone No.7' 2_ 1. U 9 4 – b3
ZlpCode: '� Fax�� I f{
E-mail: „ Phone No, l 1�J13 i
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Fill in fee simp Title Holder on next page (if different E-Mail:
from the Own r listed above) State or County License:
if value of const uction Is$2500 or more,a RECORPE�-' Notice of Commencement is required.
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