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Building Permit Application
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED bate Permit Number: M� Building Permit Application PlannJing and Development Services Bulldng 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 PROFOSED IMPROVEMENT LOCATION. Address: 1 0 (Q 3 Vn _A/ele Ur Legal Description: Property Tax ID #:c23 4 ' - o7 ( - C� r Lot No. -- Site PI I$n Name: Block No. Project Name: SetbaNks Front Back: Right Side: Loft Side: DETfi ILED DESCRIPTION OF WORK: 12, CON$TRUCTION INFORMATION: nuuiLiusiai 4YVrR 4V UC UFivrffleU unuer mis permit—cneCK ailapply: VAC Gas Tank ©Gas Piping in Shutters lectric 0 Plumbing Sprinklers ElGenerator TotaltConstruction: . Ft of Construction: Costo $ -3(v S. Ft. of First Floor: _ Utilities: Sewer ElSeptic Windows/boors Roof Roof pitch Building Height: OWN ERAESSEE: CONTRACTOR: Name Address: City: Zip Code: Phone ccs :,� Name: :-► Company: LJZ�5 1.4111-, Address: 37,5 1- r_ ►.�o 0 City: I— ► o✓ c-ce State: Zip Code: 3L-( 9 Fax: t-/ l /` -7 0 L9.3 r)✓�✓e- IC DO i ___ .c re a State:./ 71-1 Fax: No. (I ('0 tO ^ 7� _ b -C-) E -Mail: Phone No. - C-( k." ' fee simple Title Holder on next page ( if different Owner listed above) Fill in from tlhe E -Mail: LJc: Ccsrrr �l r f, 3c•µ State or County License: 0 c t a( a vaiuq or construction is :pczPuu or more, a RecoraoEo Notice of commencement is required. �,I WA