HomeMy WebLinkAboutBrodeur AC Change out Permit App pg 1 001ALL APPLIC( BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _1 Iz i In
1_ Permit Number:
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: mod -
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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Lot No.
Block No.
CONST UCTION INFORMATION:
Additi a wor to le_ne orme un ert ispermit—c check a 'apply:
_ HVAC L_I Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers 0 Generator 1-3 Roof
Total Sq. Ft of Constructio'n'rr:� `►" Cost of Construction: $ N 0(9 ,00
S Ft. of First Floor: _
Utilities:n Sewer F]Septic
Building Height:
OWNERAESSEE:
CONTRACTOR`.
Name
Name:
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Addre,{s�s: g� 5G1 Y1 i uJs (]uiS UQ
Company:( ( Vl s
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City.
Zip Code: 3dg5r ( Fax:
Phone No.
Address:
City: I�DrE al`DOe, State:_a,
Zip Code: 305( Fax:17. " (dp-373'
Phone No.131- LF(oi" 414 1
E-Mail:
Fill in fee simple Tittle Holder on next page (if different
from the Owner listed above)
E-Mail: b0\fle,0. , e, wt, i o) . P.m✓I
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.