HomeMy WebLinkAboutMyers AC Change out Permit App pg 1 001ALL APPLI ,,LIE N(FFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 � `i 1-1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 .V9/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
S
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
_ Xiti a wor to e e orme under tispermit—checka apply:
HVAC 11 Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric Q Plumbing ®Sprinklers Generator 1:1Roof
Total Sq. Ft of Construction: Cost of Construction: $ * 00. 00
S Ft. of First Floor: _
Utilities:Sewer 0Septic
Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name
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Name:
Address: a(0
Company:
City: rD Rua, State: R
Zip Code: 3LA51 Fax:
Phone No..-ilS--%2d-')612
Address:_" 1�()� FP 1M_
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City: �� plww, S`,t�a'�/te�,: i�
Zip Code: q ( Fax: 1-11-LkID'aJ13�
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E-Mail /
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail IoD�1&aL to u/1i op. MYVI
State or County License: Cl�ClBi�($(p
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.