HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Is JIL 2-0 Permit Number.
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
Li;Q 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: 5Q5II rav it gZ
Legal Description: 1�g ln� L m Jl k boy% si o"
Property Tax ID#: 3e1 l a- 5a 3- 0001 -000 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right,Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRt CTtON INFORMATION:
AdddMttiyfhal work to be ggrformed under this permit-check all apply:
HVAC i Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Q Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 77n .500. 00 Utilities- ElSeptic Building Height:
OWNER)LESSEEi CONTRACTOR:
Name Q SUci6t an Name: �,'
Address; -: Wl TI'U.al♦? s Waa company:rzr/V_!_rL [Ilf t13YkAtfidil'i,'l7(A-���rYj(r .
City: f U (��Q.ILW State: Address:-. (� (rt�t�(¢ �jtr[?!i` 9d, t
Zip Code:
-�r340i 8 a' 2Fax: City: t UC� e(G?i State:�
Phone No.!_I�3s Zip Code: S 4615 Fax:YI—X-4&i 375-7
E-Mail: Phone No.-M- 4Qf-4l4-1
Fill in fee simple Title Holder on next page(if different E-Mail•f A\110a f# fine). On(Yj
from the Owner listed above) State or County L�CAC 18I8 i a (Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.