HomeMy WebLinkAboutRinehart AC Change out permit app pg 1ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: H { Ct IZ \ Permit Number: _______ _
COUNTY ...._,_
FLORIDA
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (n2) 462-1578 Commercial Residential / ----
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
PropertyTaxlO#: 4511 ~ 5l!t ~ oooi.-ooo-3 Lot No .. ___ _
Site Plan Name: _______________________ _ Block No. __ _
Project Name: _______________________________ _
Setbacks Front. ____ Back: ___ Right Side: ___ Left Side: __ _
I O(fAH.El)DESCRIPTION OFWQRK:
~s-mn naw C\,we. Mas-tu lAb.-t--er-·Sou.rce. }fed-~mp/
~r; -11)(1 •
1s permit-c
Gas Tank as Piping
D Plumbing Osprinklers
Shutters
□Generator
D Windows/Doors
□Roof
Total Sq. Ft of Construction: ______ _
Cost of Construction:$ 4100. 00
~ of First Floor:
Utilities: USewer □Septic Building Height: ___ _
OWNER/LESSEE:
Name ~
Addr~: fOJ.f-10 •
City:j1:JlSli) ru&;h
Zip Code: 34't5"1 Fax: ______ _
PhoneNo. JJ;J.,~{,q(p~ '351./-B
E-Mail: ______________ _
Fill in fee simple Title Holder on next page ( if different
from the Dwner listed above)
Name: ~'¥-"""""--,E--'=,!'-P-~--:---;-:-:------;:--=--
Company:
Address:510 Pr
City: ffifb i)r'l(ce., State: R_
ZipCode: ·34:9sl Fax:71.:L•t{t,~-37~'1
PhoneNo.::tTJ.-%(-414:I
E-Mail:bav(eae e l,/,OhOO-C.o /Y)
State o:cJinty Licenk CAc, I~ Iii~ (I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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