HomeMy WebLinkAboutCottrell Permit App pg 1 001ALL APPLi BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q— 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 III
PROPOSED IMPROVEMENT LOCATION:
Address: ( 11
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
V]
Right Side: LeftSide:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
1.1ICQ cor ula. 4 fty\ 14 S�Ek Kui6r4& /� Cr e`vat�-(crtd� w to
CONSTRUCTION INFORMATION:
tt nalworkto e e Orme under this permit -check a app y:
HVAC Gas Tank []Gas Piping _ Shutters Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: �i`' ,
Cost of Construction: $ W Q. DQ
Sq. Ft. of First Floor: _
Utilities:Sewer ElSeptic
Building Height:
OWNERAESSEE
CONTRACTOR:
Name Mjl\\_
Name:
Add`) L" cr
ress Om
Company: r
Address: (11
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i
City:�Q ct State: �
Zip Code: &4a51 Fax:' PJA
Phone No. ?Iat - P-'64
City: K. piffu
Zip Code: 34C(51
Phone No.77-1-4W-4W
State: R,
Fax: T?aZ-L{ e -73%
E-Mail:iJ/A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail:
640.0E
Do (tory)
State of County License: eAt41_
I g 11$18 U
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.