HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 10 [ u5I 1 S 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
PROPOSED IMPROVEMENT LOCATION:
Address: l D bi
Legal Description:
Property Tax ID #: I _ oo o 3 -0Do- (o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Ulce �� I�IcQS Izicl tnne�w400 RLtt (D� l r9 seer C splen
6t 5+ vl vjlfv� 10o) heat .
CONST,RUCTION INFORMATION:
rti a workto e performed under this permit- check a appy:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
DElectric 0 Plumbing Sprinklers FIGenerator O Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 4900.00 Utilities:n Sewer 0Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name
Name: d
Company: C CoI{IMri
Address:Tp L� PaA
City: fbIv PIF,i State: R-
Zip Code:1 Fax _�.j� pC
Phone No. � a � li
Address- 5ATwAgiy� SQL_
City: Jvt
�` �� State: �i
Zip Code: 5A5i I Fax-11-1-k-elp-3737
Phone NO. -17X -1 K¢l � 141
E -Mail: •Oone, oA L
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail:
State or Cou
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.