HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:%i� _— 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: I"J I.J -
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Legal Description:
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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:
iti a or to e e orme un er is perm it - check all app
❑Gas Shutters Q Windows/Doors
HVAC Gas Tank Piping _
—
❑Electric 0 Plumbing ❑Sprinklers Generator O Roof
Total Sq. Ft of Construction:' S Ft. of First Floor:
Cost of Construction: $ �- UO Utilities:Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
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Address: �� L-J_ (AQ�I Q INA �Oi�
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Company: dii Nr UI►t7,
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City: I%iPf ¢ - State: ti
Address:! 10 EF �Ur I&O �.L(g�
city: YUr-b- Re'fc& State: r,
Zip Code: 34g5l Fax:
Phone No. AO1-PQA-3354
Zip Code: '34A51 Fax: _71a"4&(0-3373"T
E-Mail:
Phone No.-Tlg- q-�(-414'I
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County Liven e: C.AC I$ I t
from the Owner listed above)
If value of construction is $2SOo or more,.a RECORDED Notice of Commencement is required.
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aplahcations are exempt from undergoing a fuN canclurency review, room addftacuas�
accessory structures, swiramung pools, fences, wafis� -qgrL% sa u.-i rooms and accessory uses to aniodber mcn-residentol use
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Type of identification
Type of Identification
Produced
Produced
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^� t CHRISTINE WELL
p4#,ryY POBF+ ppyTry Public - State of Florida- (tea(}
CHRISTINE J. CONWELL
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Notary Public -State of Florida
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Rev. 8/2(177