HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
ouiming rerm>it Appncaxion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 345182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V/
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKWEMEN I L_OCAI ION: _
Address: IoZ 370 hau 6o,,, _&aCtz, /�Jvz/ A,� A
Legal Description:
Property Tax ID #: R 7-KAI % 000 -6t • Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
UE I AILED DESCKIP 1 ION OF WOKK:
L/l,tP 14�-r ot(e- 2-S-T�
Right Side: Left Side:
4,5 -er CA1%Ase- OaC j0/(i,✓
CONSTRUCTION INFORMATION:
Addifioa wo tr o r rme un er is permit - chec a appply:
�l
HVAC Gas Tank ❑Gas Piping _ Shutters
11 Electric EiPlumbing Sprinklers F Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 4/1i
Sq. Ft. of First Floor:
Utilities: []SeweraSeptic
OWNER/LESSEE: ----_..-._.-----,__-,
Name 10.91c a Qebo Sraa%e ea
Address:_ ,Zai lt>ood�nrdaT ��
City: IV6,V- ) State: P,"
Zip Code: /S3l7 Fax:
Phone No. dila ' .Zf D "(llv q
E -Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
QWindows/Doors
F1 Roof Roof pitch
Building Height:
CONTRACTOR:
Name: CUYCTIS YAittkAcnS
Company: C 4 S 7o rK A% r- L u S `it erK ;
Address: 14-)( S S E �/l l 1 r e'e a
City: 6 P -T St • L uci c State: r�-
Zip Code: 3+gS:Z- Fax: 7V• J.35-19&6'
Phone No. 11 �L 3 3:5- - 313 2
E -Mail: Cu stir sys f,, dol Cevn
State or County License: C G' 5 IF I I?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN IALCONS I RUC IION LIEN LAW INFURIVIAI ION:
Name: ER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicab?e
Name: i
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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