HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED // �l
Date: Permit Number: l rpy
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 41n C
15®POSE®�IiNPRQI/°EME;11lT L ' TI''ON
Address: &2 lba
Legal Description: 1 ciN .
Property Tax ID#: '�1 0. (914 - f J..g- 19 Lot No.
Site Plan Name: Block No.
Project Name: t W
Setbacks Front Back: Right Side: Left Side:
®ETAILB ®ESCRIPTIt3N aF 1IV�RK; k
f v ej eo C Ll G .j
< <� o
COIUSTR�IJCTI'ON INF®RlVIATIO:N_. _
Additional work to be pertormed un er t is permit-check all that appy:
—Mechanical —Gas Tank Gas Piping Shutters _Windows/Doors
_Electric _Plumbing ^Sprinklers _Generator J Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ fa '— Utilities: —Sewer _Septic Building Height:
OUVN'BR LESSEE . _
Name I9;�rl P i ,2 rm Name:
Address: 71�da2 Agb4112,tJ_ v Company:
City:_ t-�+' State.�L Address:
Zip Code-2? S) Fax: City: State:
Phone No.77.I- �Ls l-'7&aq7Z 2 tie a.
` „� Zip Code: Fax:
E-Mail: @_k CO M Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.