HomeMy WebLinkAboutHT Brown AC- Electrical 3 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s5`1r LUYQL .,
Building Permit Application
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:
PROPOSED IMPROVEMENT LOCATION:
Address: -]0-33 lijur rl e o
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: --
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
c electric _Plumbing ^Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ '"�i �_ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:_Z�P/} �1twP,Z4
Address: (elS i - Company: •Ali 5: �,tee4-ai
City: State:/ Address: i1c eZ
Zip Code: 3q-1 Fax: City: �F Stater
Phone No.`t ih� ,) -, � (v2 4 Zip Code: 3 1 Fax:
E-Mail: Phone No ' ,3 - f7ilo
Fill in fee simple Title Holder on next page( if different E-MaiI P_1'&J-r-Iz. q Lja. a 0.. LhnJ
from the Owner listed above) State or County License I;C )3QQ-33QC,-
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.