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Date: ____________________ Permit Number: _____________________
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ________ Residential ________
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
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:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit – check all that apply:
__ HVAC __ Gas Tank __ Gas Piping __ Shutters ___ Windows/Doors
__ Electric __ Plumbing __ Sprinklers __ Generator ___ Roof
Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________
Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________
OWNER/LESSEE: CONTRACTOR:
Name__________________________________________
Address:________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax:____________________
Phone No._______________________________________
E-Mail:_________________________________________
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Name: __________________________________________
Company: _______________________________________
Address: ________________________________________
City: ______________________________ State:____
Zip Code: ________________ Fax: __________________
Phone No. _______________________________________
E-Mail: __________________________________________
State or County License: ____________________________
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6001 Cassia DrFort Pierce, FL 34982
INDIAN RIVER ESTATES-UNIT 9- BLK85 LOTS 23 AND 24 (MAP 34/12S) (OR1200-1399)
3402-610-0447-000-1 23,24
85
3166 4159
18900.00
Kelly L Halverson
6001 Cassia Dr LARRY NEESE, LLC
Fort Pierce 3401 S. US Hwy 1
34982 Fort Pierce FL.
(772) 519-8414 34982
khalverson0817@gmail.com 772-361-6580
larryneeseroofing@gmail.com
CCC1330608
FL
Roof
Remove and replace existing roof covering
Owens Corning Shingle : NOA NO : 16-0425.01
Owens Corning Weatherlock G : FL9777-R11