HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDj� ,
Date: ��-/g Permit Number: Z �� , 3 ` '6'
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teminsummossinow 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 X
PERMIT APPLICATION FOR: 41J 1,
PROPOSEDINPROVEMENT LOCATION -` #.... Via.,. .
Address:_ q02 /Ye/J/es 3/v1 ,7enfen /goeco/ , F2. 3995-7
Legal Descriptioh: ./UC#/i'1 T ihpy d -L7•4C• (22 Y9-,2 9 7i')
Property Tax ID#: if'TO p/- /QB7 -000-F Lot No. �a,2
Site Plan Name: /1/e#/85 Block No.
Project Name: 9, ..
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping. Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
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Total Sq. Ft of Construction: 476' Sq. Ft. of First Floor: 76 I
Cost of Construction:$ /990D oo Utilities: ArSewer _Septic Building Height: eFfi
OWNER/LESSEE CONTRACTOR: •
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Name ...:1A`G71on W.. PO 5- Name: 1- t4
Address: I/y3 ,4 #/85 -f3/fri Company:,/`dg ,frni th 8o, cot f�i< • ,Al C•
City: Jensen ,ger.Gh State:FL Address: 1.6/ „/l/'•e-, i?er cee- fJ�.
zip Code: 3g(?67 Fax:/ City: cTens',e ge4c1i State:/.
Phone No. 772 3,23- y4 Zip Code: 39957 Fax:77,-23,2 a/9/
E-Mail: Phone No 772-2/64
Fill in fee simple Title.Holder on next page(if different E-Mail Q Gl g n7 fhr ±/ inc p yaiao • caw)
from the Owner listed above) State or County License C,8C/25--/y 'f
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.