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All APPLICABL INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: ®j Permit Number:
RECEIVED
DEC 11218
Building Permit ApplicatioRT Lucie County,Permitting
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:
PR®POSE® IN:PROUEMENT L®CAT1ION:
Address: 200(v /U• -;57A- 5 1;;tY Az��ee- /�C ✓(d q7
Legal Description: 6hsoLe1&-✓ /���� L� �`s C+wtcl /0 [D•3� "G
(OX- Y/6- /76/ : 16 75- t 30z6 )
Property Tax ID#: 2-0-I 0.5 - tool- CO? 3 -000- G Lot No. 4 Ali 0
Site Plan Name: Block No. N
Project Name:
Setbacks Front Back: Right Side: Left Side:
SUPER
DETAILS® DESCR;I'PT{®N C?F 1A/®Ra ,yAC �// /
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C®NSTR�LI'CTI®l� I!N1=®R,MATI®N:
Additional wor to-be pertormed under this permit-check all that apply:.,
—Mechanical-"'-' '� Ges Tank ` `�,has Piping _Shutt`er`s` �' ._Windows/Doors,
Electric _Plumbing _Sprinklers _Generator ✓I�oof Pitch
Total Sq. Ft of Construction: 71 62- Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer' --.Septic Building Height:
ODU�NER/LESSEE: C®NTRA TOR:
Nam'e� :C', 'G' 5,--- MOO�PH Name:
Address: Company: GriCDS GOx� C�r
City: _ F '} ZI' tits"c'' State: I:?-- Address s 2706'
Zip Code: 3YyY'1 FaX City::`' State:-
Phone No. 7TL' 70d , /q l� Zip-Code: y�1K7`'.:.'s£.
Fax:'
E-Mail: Phone' -1j75-'Nel/
Fill in fee simple Title Holder on next page(if different E-Mail ,�JtdCIKRSCOx-fS) C O�,ra�
from the Owner listed above) State or County License C603272-Z-5
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU`PPLEMENI"A C®NSTRUCI"I®N LIEN LAW I F�RdUlATfON: