HomeMy WebLinkAbout621 Ash Permit Application (1)ALL APPLICABLE INFOO' MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0� �� � I O 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: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: n►h J a ._
Legal Description:
Property Tax ID #: _?� 0 - 01 Y2 - MD - G Lot No.�
Site Plan Name: Block No. 1 1
Project Name:
Setbacks Front Back: Rig it Side: Left Side:
I DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe er orme under this permit - check a apply:
HVAC 11 Gas Tank F]Gas Pi ging _ Shutters Windows/Doors
Electric L_J Plumbing 11Sprink lers FI Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ iDbu
Sq. Ft. of First Floor: �� �{-.
Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JA0J
Name: Rcnl .QrY1�n
J"nY`ci cz
Address: OZ ( JgSl 1 S+z
Company: 9eJ\ X1Mi __)
fm is P101111911* r -.
City: ��- • �} . L,ItiC'.i� State: _
Zip Code: $`2 Fax:
Phone No._'-IlZ.- 911-2CllOZ
Address:
City: FL . a1 C rc c Stater
Zip Code: 3Dq'Es Fax:
Phone No. `x-12 g_1-7- -2`t L02-
02Fill
E -Mail:
Fillin fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:1'1GZ�'II.�Cllril'r-�dY�hUSrJy
State or County License: S _�
142 (450
IT value or consiruction is :>t5uu or more, a KtcURDED Notice of Commencement is required.
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