HomeMy WebLinkAboutLaBeau AC Change out permit app pg 1 001ALL APPLICABLE INFO MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED
Date: A W2o Permit Number:
,J 4
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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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 I�I PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
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Property Tax ID#:140-1 -1 01-0010-000-0 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.
rti a wor to e e under this permit -check a apply: EJ
HVAC E] Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
Electric 1:1Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 3300.00
S Ft. of First Floor: _
Utilities:n Sewer E]Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address: -IS oot° Rw� -Or.
Company:$aV/Q Ri( lt►rXijj,tdldma AU
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City: 65dY� P64/ZG State
Zip Code: M61 Fax: C�
Phone No.l UZ5J
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Address:50 5 A t (lj 81�
City: fbf-b I�(efce./ State: R_
Zip Code: S 41 5 p Fax: -7u-" 4btP- 73`I
PhoneNo.-Ml-- �Ya[-414-(
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:�A,41P_OA& WLYtno. Ct) rn
State or County License: C./iC l$18I $ (D
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.