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ALL;APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dote: Permit Number:
1 -
WINE
Building Permit Application
Plapning 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
PEOMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
PR POSED IMPROVEMENT LOCATION:
Address; (0 ( L - 4--
Legall Description:
Property Tax ID#: 3 e / 9 - /+Cr o C?�
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:-Right Side:`Left Side:
[��.�ILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona work-tope rmit-
e e orme un er t is c ec a a
pp y
ElHVAC Gas Tank ®Gas Piping _Shutters
i Windows/Doors
El
OlElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total$q. Ft of Construction: S . Ft.of First Floor:
Cost o!FConstruction:$ cI `� �` UtilitiestSewer OSeptic Building Height:
OW EIS/LESSEE: CONTRACTOR:
Name 104-r r. ,* Name: ti
5. c,l -c
Address 9
+` < c Company:ompany: l.�c: 1.4
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City: ``� �.. - State: E.L Address: 3 2
Zip G de: �`f $ x-
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Phone No. City: ' f State:
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Zip code: Fax: I I ID7
E-Mai : Phone No. - `�
Fill in�ee simple Title Holder on next page(if different E-Mail: Cal
from the Owner listed above) State or County License: C [,
If value'of construction is$2500 or more,a RECORDED Notice of Commencement is required.