HomeMy WebLinkAboutBuilding Permit ApplicationAll AE PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )_ -,() I Permit Nur
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Building Permit Applica
Planning and Development Services
Building and Cade Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PER IT APPLICATION FOR: �e- Y-) A--\) C)l
PRQPC7SEDAMPR t-." EyNT LOG�TION"
Address: ifog.-k�- J�,'° j + LN 4
Property Tax ID 4: z ) 10,2 n 0 D - Lot No.
Site Plan Name: Block No.
Project Name:
DETAfL�D DESCRIPTION OF,AM'
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New Electrical Meter Second Electrical Meter
CONSTR(1CTI®N INFORMATION M °�
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors , Pond
_ Electric _ Plumbing `Sprinklers ^ Generator ^ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
1
Cost of Construction: $- ZQ Dltilities:
—Sewer _Septic Building Height:
OVt/NERjLESSEE '
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_.U�:`,� ¢.Liar{...,=CONTRACTOR
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Name
Name: G i
Address:oZuoc nm�oya c-�-.
Company: '
Address: 3a22S Y {� P�
City: W-ekk11' Stater
Zip Code: -C� Fax:
City: Stater
Phone No. — `1 O 3
Zip Code: Fax:
E-Mail: Iin ni t-
Phone No -
Fill in fee simple Title Holderon next page (if different
E-Mail '11 C
from the Owner listed above)
State or County License
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If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.