HomeMy WebLinkAboutBroad AC Change Out Permit Pg 1 001ALL APP!I INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: I I3 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Port Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ��
PROPOSED IMPROVEMENT LOCATION:
Legal Description:
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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wifh (D kW head
CONSTRUCTION INFORMATION:
rti a wor to CFJC dime un ertI ils permit -t e all imappy:
HVAC 1:1 Gas Tank ❑Gas Piping _ Shutters O Windows/Doors
Electric Q Plumbing Sprinklers Generator ❑ Roof
Total Sq_ Ft of Construction: GG SqFt. of First Floor:
Cost of Construction: $ utilitiesSewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address:I
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Company:U V11 ffir�7llAtfjby7dif6
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City: ( (0 irk"P State
Zip Code:.34QS I Fax:
Phone No.ma313 -3(p 1) 1
Address:- 106 t "�CtrrlAl_
r
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City: fb(-i'i q([ fc&
Zip Code: -3 4q 5 )
Phone No.-"P-- of
State: F�f_
Fax: 77.7.- 4&(4 -37S-7
-41+1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner ffsted above)
E-Mail:
on in
State or Count ty license:
CAC,111_313
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