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HomeMy WebLinkAbout10.13.2016 - Permit Application for Duraseal of the Treasure CoastALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �O` \3 \ \� Permit Number: _ J _ f?ECE�� �D ��1 13 2016 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 1 G PROPOSED IMPROVEMENT LOCATION: Address: 955D i1n LLm 3Lr'9Z Legal Description: &( fD DV Lo -11-3 1 Property Tax ID #: Site Plan Name: Project Name: Setbacks Front 2ObR3t-� Z Back: Right Side: Left Side: Lot No. Block No. DETAILED DESCRIPTION OF WORK: I lrcC CONSTRUCTION INFORMATION: CONTRACTOR: Name Lz,G U-) Y) I, hAXAAV`" %I AdditionalWorKtolbeoertormed under this permit- check j all that apply: � i City: i� %� S� , LW U Zip Code: 3Li��J�— Phone No.- Z -S-ICI • OH`WAC �I Gas Tank []Gas Piping Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: ('' _ • nd- State or County 'Liicense: 73 G q 2D) Shutters Windows/Doors 11 Electric ❑ Plumbing. Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: V V S. FtFtj. of First Floor: Cost of Construction: $ 1 �LfS'� Utilities: L_1 Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Lz,G U-) Y) I, i nr_ Name: C,U -I Addree(sss::�i S us `"rw�! � Company i City: i� %� S� , LW U Zip Code: 3Li��J�— Phone No.- Z -S-ICI • State: Fax: � M "W' F O I ""lel Aq11,ml��� Addr s: T 1 C Spj`,l) �'� I Lel City: 6hyl t ,awl Stater Zip Code: NCKID Fax: Phone No.'] % (C! -Lq?0 �� E -Mail: I (.��J1'ia'V VI+A ©CCYY\(CL. f- I'll Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: ('' _ • nd- State or County 'Liicense: 73 G q 2D) If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.