HomeMy WebLinkAboutBuilding Permit ApplicationALL APPUBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4q,1-7,1 Permit Number:
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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
PROPOSED IMPROVEMENT LOCATION:
Address:_ 5 (7( S IQ% JT1Jrf
Legal Description: QI l
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Property Tax ID #: 131A500 - D019 -000 -P-- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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STRUCTION INFORMATION:
tItiowor to e e orme un ert ispermit—c ec a appy:
❑Gas Shutters Windows/Doors
HVAC Gas Tank Piping _
E]Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction:
t� 5 Ft. of First Floor:
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Cost of Construction: $ I f !/y�. Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: _
Name ID
Name: l Qi
Address: Jr 03 f1Q$ I(
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Company:
City: � Q`._, Stater
Addres/s:5WS fk 1.tf/l'�
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City: i) RJ1,0�i State:
Zip Code: '5051 Fax: tS
Phone No:77� �1+�r�- �®�0
Zip Code: 5) Fax: a2' 0l0 -3?3'
PhoneNo 11(
E-Mail:PJA
Fill in fee simple Title Holder on next page (if different
E-Mail: kaj 10-M,(1)qrl ko, !^DYE
from the Owner listed above)
State or County License: iI AC1 R I R(R
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.