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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: (�G� L �U+ �lq Permit Number: � '�c �
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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: (0 44
Legal Description:,
Property Tax ID#: /30, • 11 l •om - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION ' {
Additionalwork to e e orme under this permit—check a app y:
HVAC Gas Tank ❑Gas Piping _Shutters aWindows/Doors
Electric 0 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
' Lid
Cost of Construction:$���� Utilities:11_Sewer 0Septic Building Height:
OWNER/LESS:EE
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CONTRACTOR
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Name �A�', _ ^" Name:
Address: -- `3' f E�C� Company: ' G C�?`yli�C 1•
City: iE' ..��. a '' ;' State: L Addres 5 ..........
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Zip Code: Fax: City
: ��ST �yC.LE State: Z .
Phone No. 90 - 3 ` 9 Zip Code:3-1 Fax: z9 2 9-4?-?S—
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: " -4t-C 72_ jk � 4
from the Owner listed above) State or County License: e yco S-,9,S 03
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.