HomeMy WebLinkAboutAlton AC Change Out Permit App pg 1 001ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 3 H 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 II�
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
-mli P , bIk �23 LSF--J,
Property Tax ID #: U (a -510 -t)gA l -1700 ,() Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I; DETAILED DESCRIPTION OF WORK: ;I
b4, &- Ulu- -r* mml (2) 2ter)/ 1(0 Seek "Z&A- PU-41T Ale
s4 s-iRxis w i-m 4 Kw baelc u f Ktxk�
('CONSTRUCTIONINFORMATION: I'
Pufflitiarnal work to hpna nrma un art �c narmrt— �FurL �(Ir+�.,., .,•
L�1
Gas Tank []Gas Piping
❑Sprinklers
H Shutters Q
IlGenerator ❑
Windows/Doors
Roof
CIPlumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 5000,0()
Sq. Ft. of First Floor:
Utilities: L_ISewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �i(ii'(G +7J
Name:
Address: J 0 IOMi7 f
Company: I& N(' &d fi�JJ�, IJAA HO- 19411i1Cr
CitylRot I/,�i,lP L State: �
Zip Code: 3i}q�Ja- Fax:
Phone No.
.
Address:310� A _1FtM0(kR_ �?rti9t
City: �bfb-gefcz, State: f%L
Zip Code: 3 4q 5 ( Fax: -71�2-- L(& -3%3-7
Phone No.-i-ig- 4-W-414-1
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail:
}�t(Qp(+ EJ hOt1. .O A`1
State or County License: CAC rz l s l $
u vame of construction is >uuu or more, a RECORDED Notice of Commencement is required.