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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 -dk•((0 Permit Number:.
RECEIVED
Building. Permit Application MAR 31 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ,�-
PERMIT APPLICATION FOR:
Address: I nyl ,,nnCkl
Legal Description: ��O rC dl �vlo' "N SL L& I
Property Tax ID#: 3()1- ((i C)-? - 0 3 S7G - 000 c5 Lot No.
Site Plan Name: Block No. s sr
Project Name: I Qt e-
Setbacks Front Back: Right Side: Left Side:
' CtC W - l:_ a-k 6 �'I k 44-e-
rtiona work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ��I•o Utilities: _Sewer _Septic Building Height:
Name_h Q 6CxeI-) 1 c f y Name: 5C t,"- Y-(crK3
Address: Soo Company: gC(em1 Fcn
City: a- Pt'-t State: (Z- Address: 1 906 $'1'N S--
Zip
- -Zip Code: 3ugi$'( Fax: City: U-Q(v 2>.m- c i-\ Stater
Phone No.-71a-5\ R -8 h^7 Zip Code:3a`3 G a Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
Lfrom the Owner listed above) State or County License 2-7 02 B
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.