HomeMy WebLinkAboutBuilding Permit ApplicationALL /'PPLICABIE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- J
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort fierce 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
PRO ° OSED IMPROVE MENT.LOCATION:
Address: 4 Y<f 7
Legal Description:
PropeltyTax ID #3 y 3 - 6636 -Ccb __ 0
Lot No.
Site Pl,on Name: Block No.
Project Name:
Setbacks Front Back: Right Side: left Side:
LPET41LED DESCRIPTION OF WORK:
J'
CONSTRUCTION INFORMATION:
Additional work to 13a er orme under this—permit — c ec a appy:
0I
�
VAC Gas Tank E]Gas Piping _ Shutters ❑Windows/Doors
lectric El Plumbing OSprinklers Generator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
—1
Cost of Construction: $ 1 Utilities. Sewer SepticBuilding Height:
OW-ER/LESSEE:
CONTRACTOR:
�* ^
Name; �� Name: a ..� ✓�
Address: Ll 1l6 pec" r'Wa a Company: C. , 4• r
City: - [a+'r State Address: -37 , „ ,e ,—
Zip Code: 3 L/5,6%1 Fax: City: 1 , c (ce State: J2
Phon No.__9 `7_! �e-f f3 Zip Cade: Fax:
E -Mail: Phone No.�(Q
Fill in fee simple Title Holder on next page ( If different E -Mail: LAj � r c a r, 41
from the Owner listed above) State or County License:. AC aA 3 rG' %
If Valu of construction is $2500 or more, a RECORDED Notice of Commencement is required.