HomeMy WebLinkAboutBlanchard AC Change out permit app pg 1 001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2�6 120 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
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: (Pbg3 U.ICO- iRW Ve. 6)(+'Rerte S4g6l
Legal Description:
Property Tax ID #:
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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:
HVAC U
Gas Tank ❑Gas Piping
Ll Shutters Q Windows/Doors
Electric 1:1
Plumbing Sprinklers
0 Generator O Roof
Total Sq. Ft of Construction:
Cost of Construction: $ �(
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Sq. Ft. of First Floor:
Utilities: SewerOSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name -;no&
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Name:
Address: 3 )V'1 r_ 2M ( ALL
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Company: Boyle- Eft(
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City: rba _Ph''na2 State: �
Zip Code: S4q 5 I Fax:
Phone No. �J . - �$1
Address:510 Pr-&MPfk.9
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City: fb(b rl efce�
Zip Code: S 4q 5 !
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State: R_
Fax: ??-L- 4150 -3731
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E-Mail:
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
E-Mail: ./iPnn0 VAIlQO.
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State or County License:
CAC 1$ I S 1$ 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.