HomeMy WebLinkAboutScan_0020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 16 -A - d1- ) Permit Number:
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
PFRMIT APPLICATION FOR: YY\idla�rllCa
PROPOSED 1MPROVEMENT LOCATION:
Address � 0e++Fkeel ti50�-Sol-{7�j► -ODO�g
Property Tax 1D #: Lot No.
Site Plan Name: Block No.
Project dame:
DETAILED DESCRIPTION OF WORK:
P I& .n 4 0 0 N; _ 3 V1 +OAk
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing T Sprinklers
Total Sq. Ft of Construction:
e�
Cost of Construction: $ `�1 4 C1 OQ .
if S
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: m\c4 , tu CO&A _
Address: -1 a R,,r_tI_CS (2>\,jA
Company: N C t5
City: _J_0Xcr-dll' State:,
Zip Code: 4 9! 7 Fax:
Phone No. 6), IS G ICl -
Address: I;Lq L 59
City: Fff ::5� L4A►.Gi e __ State: I
Zip Code: 3 H aS a- Fax: 36 -3314
Phone No -2'el - �L3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 0 dt n+4Gr0r�Ses� dv GoM
State or County License C ON- C I ILNI 'M
If value of construction is 2500 or more, a RECORDED Notice of commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.