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Al! APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date;
Permit Number:
-7 7. #1 M4 C "7
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Iding.Permit Application
Planning and Development Services
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Building and Code Regulation Division Commercial Residential 4 � /000
2300 Wrglnia Avenue, Fort Pierce FL 34982
Phone: (772) 462m-1553 Fax: (772) 462mP1578
PERMIT APPLICATION FOR:
OPOSED IMPROVEMENT LOCATION:
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AddreSs:l�M
Property Tax ID #: �Lot No.
v1"' ��� j ' �(�" �
Site Plan Name: Block No.
Project Name:IP
DETAILED DESCRIPTIONtOF WORK:
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LAI me
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New Electrical Meter � Second Electrical Meter.
CONST,RU ION INFORMATION:
Additional work to be performed under this permit — check all that apply:
/ Gas Tank _Gas Piping Shutters Windows/Doors _Pond
✓ Mechanlcal _ Pitch
5 rinkle�s Generator _._. Roof
Electr00
ic _ Plumbing —. p —
Sq., Ft. of First floor-ev
T.Otal.-Sq-4 Ft of Construction: i3WIldingHeighta.Utilities: _Sewer _Septic----
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Cost of Construction: $
CONTRACTOR:
OWNER%.LESSEE: Name:
I Vol t ;e.S ► c,
Name 4W Company:
JCL 0Ad dress:11 L4S
So State:��L Address' State: f�'
City: Fax: ��2v9 S'"� Fax&
Zip Code: Zip Code:
VL
Phone No. W"PEA Phone No,- �C , jj e, _0
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�f different E-Mail 501 .... ....
hilt infee simQ�e TitEe Holder on next page � State or County LIcense
ftot" the Owner 11ste above)
glim flr more. a RECORD e ice Of COM"nf �mmencem�n�s rquired. ent 1 11 5 1111111111 if �NEW.
!f valsee of �s��an iM-oRECORDF-Dif value of HAVC is 57,500or �fe� eW.- W PW
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