HomeMy WebLinkAboutKoehler AC Change out permit app pg 1 001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Cq %
Permit Number:
1 J
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: 20 d.
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Legal Description: �ic't0(I�_Cltz 0-0-Di? Und Socl
Property Tax ID #: (9 3 3 -50 t}•- Q23 3— 0 00 - 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
"DETAILED DESCRIPTION OF WORK:
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INFORMATION:
VONSTRUCTION
wor to e e orme un ert ispermrt—c ec a appy:
C —]Gas
Gas Tank Piping _ Shutters Windows/Doors
Electric EJ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S� F�tj of First Floor:
00
Cost of Construction: $��� • Utilities: L JSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name'
_ Name:
Address: Wit. } uCf C alVl� F 309 Company: � s; �
Jile
City: hiP%(� State: _ Address:5(Q A TL{pryl ifClL )
Zip Code: 33 l It (a Fax: City: fb(-b- K fc& State:
PhoneNoTs-q;L� - '-72-50 Zip Code:.. 13 0 5 } Fax: ??;- 1{P -373'T
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County Licen e: C/kC I$131$ (p
If value of construction is S2500 or more, a RECORDED Notice of Commencement is required.