HomeMy WebLinkAboutPermit Application St Lucie-1.pdfALL APPLICAUE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Permit Number:
Date:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce Ft 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: CK �� r, �z.� Cc rt S
Legal Description:
3 LA 1 S S (D 'A 1 �0 Ob Lot No.
Property Tax ID #:
Block No.
Site Plan Name:
Project Name:
Setbacks From Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
c nT1561
CONSTRUCTION INFORMATION;
Additionalworkiouegicildgme un er isperm ec a app y:
❑Gas Shutters ❑ Windows/Doors
HVAC Gas Tank Piping ��_jj
❑ ❑Sprinklers OGenerator Roof ofp Fodch
Electric Plumbing
Total Sq. Ft of Construction:t S Ft. of First Floor:
❑ Building Height:
` Septic
Cost of construction: $ '-1 1 Z-O D Utilitiesll Sewer
OWNERf LESSEE:
CONTRACTOR:
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Name 2_t�nA1 0.YY S
Name: ��knC,S
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Address: ( fly ;. ". ,n�.o � ��v
Company: t�,'t"
�'o S r�-A State: IF L
Address: i 3+ A IP4`aa�Sc�
City: 'For I State: F l
City:
Tip Code: Fax: l'
Phone No.
rp Code: Fax:
Phone No. Z G-z, t Ct$
E-Mail:�(�from
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E-Mail:
Fill In fee simple Title Holier on next page ( if different
the Owner listed above)
State or County License:
If value of consmcdon is $2sw or more, a RECORDED Notice of commencement is required.
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