HomeMy WebLinkAboutBollon AC Change out permit app pg 1 001ALL APPLICABIV INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date =3 23 20
Permit Number:
MOMi
Building Permit Application
Planning and Development services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 J/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fine
POSEDPROIMPROVEMENT LO
I {7_ P; CrA1AddresTION:
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Legal Description:
Property Tax ID #--
Site
:Site Plan Name:
Project Name:
Setb k
Lot No.
Block No.
ac s Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK,
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yW Acssf�� ��, 5 �w b �e
1:
nvAL L J Gas Tank
Electric U Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _�-1 09. 6D
IVNER/LESSEE:
Piping UShutters ❑Windows/Doors
nklers Generator Roof
S Ft. of First Floor: _
utilities:Sewer Septic
Addr{ess,::-kJ r� 2 rdale Cif.
City:V-1 (%jQr(D State:Ri
Zip Code: Fax:
Phone No. 06 _ 6A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lely 1 KAL I UK:
Building Height:
Name: MI�C_1L
PAY 1a
Company: LL��r� !TS( my"l-14'r6la ;
Address:510 Pr -JUM f/uL
City: F47f�fAf!?rC?i State: R
Zip Code: '3 t{ -Q 5 + Fax: ??a-- 4& -37-S-7
Phone No. -"g-4W-414-1
E -Mail: P \t!t i10l7 1) m
State or County License: COC1818f'8
If value of Construction is $2500 or more, a RECORDED Notice of Commencement Is required.