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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 E
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
P'R'Q,PQSED 1 ;fRQ,EME1' LC), AT11 :
Address:
Legal Description: !
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Property Tax ID#: I -(00-7 CJoZ OCaL i' Lot No.
Site Plan Name: Block No.
Project Name: rc�U
Setbacks Front Back: Right Side: Left Side:
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pETAI n��D D:u.GR 'TION ` n tNO
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Additional work to be pe rmed un er t is permit-check all tat appy:
: /eanical _Gas Tank Gas Piping _Shutters !' Windows/Doors
lectric Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ :z 7,f 5-; Utilities: —Sewer Septic , Building Height:
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Name Name: /2 .
Address: Company: - G
-71
City / '/ZG e- State:_ Address ,
Zip Code:��4.S-,� Fax: City: State:
Phone No ?�� 3� c c2 Zip Code: 1 Fax: Z�o?"J�•� I s
Phone No 7 .�
Fill In fee simple Title Holder on next page(if different E-Mail ;RAI e ' Ivy'
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.;