HomeMy WebLinkAboutLey AC Change out permit app pg 1 001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �20
—A Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 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:
Add10ress: D i
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Legal Description: `jn�/,ffi
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Park,
Property Tax ID#:-Z5-0- Zll -00%s- QC015 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:
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HVAC
[:]Gas
_ Gas Tank Piping _ Shutters Q Windows/Doors
Electric
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Plumbing Sprinklers Generator ❑_ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ gOO. (� Utilities: Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
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Name:
Addressgol N i(St /Q
Company: t /I
city:IVI, �l 6t , State: r-
Address:510 1+ T ffl lZf k.L Ettdk �..
Zip Code: 33Fax:00
City: {'bra (7(�Off-Qj State: �
Phone No. f. L7IE i� S1e9 Gi
Zip Code: S 49 5 i Fax: ?7;-L &(a-373-I
E-Mail:
Phone No.-TJ L- LUp(-414-1
Fill in fee simple Title Holder on next page I if different
E-Mail: (�yfPnn EL/ hnp, n ftl
from the Owner listed above)
State or County Ucen e: CAic , I81'813 (y
If value of construction is $2500 or more, a RECORDED Notice of Commencemem
is required.