HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I'm, M Permit Number:
9 !la
' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:�i
PROPOSED IMPROVEMENT LOCATION:
~Address: 1 `7 q p e,*1e5 S l yJ Fa rcc 1 T A
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: 1
W
%Lf vl — I,
New Electrical Meter Second Electrical Meter
� CONSTRUCTION INFORMATION:
S 4- Ln o I o Kca kn; f 10
(Affidavit required)
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: $ dv ,� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name a:' F i (-,%
Address: 11 - Pt-WIC-5 81 J
Name: e Vz Cod` b ill
Company: D asl A E A-k ir'u¢ �nc
City: --Tif6An &-,% C'� I State: f II
Zip Code: 34q s Fax:
Address: I 1 Se - - s iii'a�_ e iy _
City: 4ot! 4 Sic Ly�c e . State: FL
Phone No. 95r4, )'f• 3 - gy 1 CI
E-Mail:
Fill in fee simple Title Holder on next page if different
zip Code: _34'iS fax: 3 3 S • 33 0
Phone No 351 , �L I 4
E-Mail oldenj5�rpn ses 1P LoU . C44A
from the Owner listed above)
State or County License CM C 1,%tJq6J !N
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.