HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number:
RECEIVED
Building Permit Application rani 14 2019
Planning and Development Services
Building and'Code Regulation Division , Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St ' !de Count
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: ci`-15_< w n.a�• �+ C:C-C ke t 1--or+- ?;-C A. C_
Legal Description: ?-O-\ rr\ S?,r-e rzZ S V10\0 LIQ y Of - 3
C Or ?-C100 - I Lail 1
Property Tax ID#:_ Q. b i 0 - S00 _ Q0 31 - 000 ` cI Lot No. 1�(
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF WORK:
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11:CONSTRUCTION INFORMATION
Additional work to be ertorme under tispermit-check all appy:
11HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors
aElectric R/ Plumbing Sprinklers F Generator F] Roof Roof pitch r
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ %-0 0.00 Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE. CONTRACTOR:
Name nr�p()zu, 1r . Qere -L Name: Csct-r,,. F,err:S
Address: Company:_ _ ZW,-p—L 91u
City: -r-o r P: s"C State:�, Address: q-) t - S. L1 S L4,..>�� 1
Zip Code: 4 Fax: City: C--t P.-er-Le State: e(I
Phone No. q ,5-L(- �;L`{(o - ciLa 3 Zip Code: `3 LLOt ka Fax: A)L 4
E-Mail: Phone No. `1`1 Z.- (o Z a-9-0
Fill in fee simple Title Holder on next page(if different E-Mail: 120 n,•y Wt-o-r.: I . t v n
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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