HomeMy WebLinkAboutAckeridge AC Change out Permt app pg 1 001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: QL12-0 Permit Number:
o a_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 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 III PROPOSED IMPROVEMENT LOCATION:
Address: IJ!
Legal Description:
Property Tax ID #:
Site Plan Name:
Prniert Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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Lot No.
Block No.
CONSTRUCTION, INFORMATION:
Acldditji a work to be
perform
orme under this permit - check a app y:
HVAC Gas Tank [_]Gas Piping _ Shutters Windows/Doors
11 Electric E] Plumbing Sprinklers 1:1 Generator 0— Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ oo • oo Utilities:Sevier 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
er
Name: Kadgf,-pl-
Address:t?q? 5 chf1CGLVl'fGtf(a(7
Company: �2 �a Q_ rn(
U1fl7J f (QVI&1/A
Rife.
cityPr er(� State
Zip Code: M5 i° Fax:
Phone No. 2 r? i - S +2_G
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Address:5r� PrTumtlikCL &PPrii?EBdY .
City: fb(-c e.,,
b- I (
zip Code: 310 51 _
Phone No.-M.-
State: �L
Fax: -71,2' 4&0 -37-S 1
-414-1
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
rn
State or County Licen e:
CA-C I$181$ (Q
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.