HomeMy WebLinkAboutRevised Building Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tQ 1 I ` 1 Permit Number:
ISS Q0 I `116 Nao vifa-rE�k 61 Z P- `
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-157$ Commercial Residential V/
PERMIT APPLICATION FOR: , o' r a e ` f_CA__)an ►CO3J
:r !r�, fit. •'�i a'. ,,;. & .�'.
Address: U'�U ICYY?I SD5 ,3 1-�Ioi n-r 2,I--> '?C(Zr kM. WGY'�
Legal Description: (ZEPU'9CQ) f� )Cr t-)420 eo f l_Jl V--� L4 W_C- CH
Property Tax ID#:Ea-i _ -1(,)L4OOI' Qd(3— J _ Lot No. 13
Site Plan Name: ibn-)P-'o,-,j 17b f)T' �?_oN1> VVb C:-,I� V Block No.
Project Name: MI Ci'-OL P_A 'C_)4Qn W f7(�Ll
Setbacks Front sack: Right Side: Left Side:
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Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing ❑Spp7rrinklers Generator g Roof
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Total Sq. Ft of Construction: CO� _t Sq. Ft.of First Floor:
Cost of Construction_$ _T9� Utilities:0Sewer USeptic Building Height:
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Name 0J?. NZQV-4 %S Name: r1Py CgPd) ) -.11 (
Address ]2M k5D lAJ Ppi nT Y& Company: uyf f -,
City:EQ 1-6-r L)LkCA C, State: , Address: 6)D q SC 1)00f,
Zip Code:26:Mb _p Fax: N 0. City:s ?;Y— State R,
Phone No.-J"1'd L4 b U`dl I l__o i Zip Code SH q0i H Fax: `I'I' ?� 1055
E-Mail: N I Q. _ Phone No.2 'aq)_1 I fYrl
Fill in fee simple Title Holder on next page(if different E-Mail _ QJ1 l'IYIU ur(a�� C-C !?p!Y")
from the Owner listed above) State or County License: C 01.4 ry7
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.