HomeMy WebLinkAboutScan_0022All APPLICAcBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U' �'' Xi 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
PERMIT APPLICATION FOR: rf\e
PROPOSED IMPROVEMENT LOCATION:
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Address: ® h ced S'76-7-07-0;i-0410 - O
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
1 DETAILED DESCRIPTION OF WORK:
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New Electrical Meter
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Second Electrical Meter
CONSTRUCTION INFORMATION:
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(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 J Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 9. t70 . OR _ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name r� Selw, S Name: qxfyCa i
Address: 3u (7, A- a � Company: 2Od � 1ti� I`i 5B5 � G
City: &f+ 5+_ 4L1Ci •2- State:] Address: 13'5 b 5 E' � !� %l
Zip Code: a Fax: City: St- Stater
Phone No. g 0 Zip Code: 31 Fax: Sz"55- 33 to
E-Mail: Phone Nog
Fill in fee simple Title Holder on next page ( if different E-Mail C�Jok �nfie,f riSSQ �� • o4v►n
from the Owner listed above) State or County License 6M6 1 2-5
659
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.