HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '� s4f ' UZ4 Permit Number:
LUYLHI�
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: k'
VIZ
I PROPOSED IMPROVEMENT LOCATION: — I
Address: 77�G 0
Property Tax ID #: :72424 ° OQ9 • G-0'71 ' 66d ',5
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additiio al work to be performed under this permit - check all that apply:
VMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Constructio//n:'I Sq. Ft. of First Floor:
t, Cost of Construction: $ / 224e7, 4V Utilities: _ Sewer _ Septic Building Height:
Lot No. I
Block No. 70
OWNER/LESSEE:
CONTRACTOR:
Name
IYie�
Mml e4JL
Name:
r_y-L
'e-Im a
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Address: 'J
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yK.
Company:
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City: �Q 6 State:
Zip Code: f Z Fax:
Phone No.
Addr ss: ` ' M&dr I
City.
Zip Code: 2- Fax:
Phone No
State:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License(
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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.