HomeMy WebLinkAboutBuildling Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ,�LinC'"_ '? N i>?(�� Permit Number:
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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) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: VS -0 1 -1 0 (' 0 9 7 Y_ 00 1) ` )_ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 11
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Block No.
CONSTRUCTION INFORMATION:
rtOna wor to e e orme under this permit— check aapply:HVA0GasTank ❑GaPng Mutters
❑Windows/Doors
11 Electric Fj Plumbing Sprinklers 11 Generator ❑Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ (Z ul cc; , "i,: Utilities:0Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name F5 u V? /I I I?; t?,r',Vii
Name: fv')s c. h c: r i
Address: ,�q,Q d,e4_+(e P3K; d
Company:
City: 3C!0�2c n State: i L
Zip Code: 'i' f c4 S-% Fax:
PhoneNo. IL51-7 i °So --7)
Address: L- Cxc 't - B, f
City: l G(,x C_,. -,
ZipCode: 3—icfciu Fax:
Phone No. / 7 Z;� �.i; ii �5� 7
State: FL
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E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 0-, PY LS S'1) ee rv-?,, `i -o 1 £>
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State or County License: Q_ A C. (S
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.