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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 4 70 I--k�11'e. IU
Legal Description:
Property Tax ID#:,- Lt�'+,4- — -ocYo - cxo -- ,a. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
j Lt
v A<C,
CONSTRUCTION INFORMATION:
Additional work to bEIrtormed under this permit-check all apply:
CIHVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
❑Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Constructionr:, 5 Ft.of First Floor:
Cost of Construction:$ `7 Utilities:OSewer❑'Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name N,,—,'r, 1, rf Name:.
-- ;. .
Address:q'Zc�-5 vne.`�7 `(`- • Company: �c� i ��k�.:'�.
City: -e� -Ce State:_ Address:3�� ellC!E�M Q ii�P
Zip Code: ci`G Fax: City: State: ; -
Phone No. Zip Code: 6 5l Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: I.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.