HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
I J - -
Building pp 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 grow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 76 6 5W r 11 C -f -
Legal Description: ral,p w
Property Tax lD #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Re�1wz,,,v\e,,1A ' �\ c=' c i t h
Im
Lot No.
Block No. L' 9
CONSTRUCTION INFORMATION:
A ititiona work to be
rtormed under this ermit –check all tit apla y:
LJHVAC L�J Gas Tank ElCas Piping❑_ Shutters � Windows/Doors
l] Electric � Plumbing OSprinklers L =1 Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
OWNERAESSEE:
S Ft. of First
j Floor:
Utilities: Sewer I—I Septic
Name Ma VILA 1 Kyo 1'0
Address:_A�55 R_ 424 Cws5b'll
City: P 5)_ State: FL
Zip Code: 2? /q52 Fax:
Phone No_2'�,,� _ U7– 99 09
_..
E -Mail:.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed abode)
CONTRACTOR:
Name:
Company:
Address:
0
Building Height:
City: 1 .--> L `" State: 'r(_
Zip Code: 2,1gXC, Fax:
PhoneNo.
E -Mail: w e,c d '( Nc 01 'koc • cy3 v)
State or County License: L i'L� f �'f 7CSI T
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required_