HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED T
Date:
RECEIVED (vim
� � Permit Number:
APR 2 9 1011
1 LLCLL W111, KAREN S. NIELSEN
State of Florida-Notary Public
( 1
_• *= Commission # GG 207484
[ a .- •s L �'' _ . -_ c�, P; My Commission Expires
Building Permit App C , do June 12, 2022
Planning and Development Services /
Building and Code Regulation Division Commercial Residential ✓
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: V -`v�a0vi
-Plt IMPROVEMENT LOCATION:
Address: Pg01 Je,44�rson '?C).(IC_t..)Gl.J , ro(-4- t"'i�✓CQ. . .
Property Tax ID#: t y oZ -1 0 a - t 3 a() ` 00 0- 0 Lot No.
Site Plan Name: , ^ Block No. 5 Q
Project Name: r�P�aClZ fioN 11 GV WS
ET -ILED DESCIRIPTIOWOF WORK:,
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New Electrical Meter Second Electrical Meter
NFORMA11ON:
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:
Cost of Construction: $ R 190 0. oe Utilities: —Sewer _Septic Building Height:
OWNERf LESSEE: CONTRACTOR:
Name He(t CI(A-j 0-Ir Name.
Address: � $0 1 J C-Gec fSpr-, \i Company:
City: eo 6-11,- .9"t G (C-e State:Y'-L_ Address:
Zip Code:3(19 L-t. �— Fax: City: State:
Phone No. 11 .�--�"�fig' g 3aq Zip Code: Fax:
E-Mail: LTR 1 a S(&NOS-hoo •UU►'r 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.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.