HomeMy WebLinkAboutCCF02262019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ',26 L% Permit Number:
1 i ; _ON•
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auilialing rermut Hppiicauon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial Residential
PERM I APPLKi A I ION FUR: To Select from dropbox, click arrow at the end of line
PROi'OSED IMI'KOVEMEN I LOCAI ION:
Address: 70
Legal Description:
Property Tax lD #F: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UESCRIP I ION UE WORK:
LIl{L /Z,• L,li,t- A l�fSc<< ���rgc 0�'
i CONSTRUCTION INFORMATION:
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-AddItiginal work to be oer orme un er t is permit — check a app FY: —
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric OPlumbing Sprinklers Generator Roof Roof pitch
Tota: Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: 1:1Sewer DSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 40o15 f Sn5-tamc,E 20 Name: CU%T(S ti�AatikonCnS i
Address: oP/'%O /5/�!: ��o% �i Company: Ct( S7r, m A � � 5
City: 1-0011 7- S,- State: FL Address: t �7I 5 i / l I aG _t r ee ok t�
Zip Code: SO Y.7- Fax: City: ��% fZT .2t. <_ i c(it_ State: r� i
Phone No. M - J?I • cP77.2 • Zip Code: Fax: 77J-
E -Mail: Phone No. 3 3:5- 10 j- 3
Fill in fee simple Title Holder on next page ( if different E -Mail: C u S t cz r S y s £ Cc o ( c [,VIA -
from the Owner listed above) State or County License:
i
tf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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