HomeMy WebLinkAbout192 JEFFREY LN 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 911 Permit Number:
S51r.,
L
o � R ;
4.:1 A.W.° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercia
2300 Virginia Avenue., Fart Pierce FL 3498.E
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ELECTP"1C�L
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax I D #:
Q2
-8o3- ot)o8-(x)o
FTO-op- I e"ekl:
Residential
rL
. 34a8a-
Lot No.
..2
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
-&(e� I � �
�l
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical I Gas Tank � Gas Piping _ Shutters Windows/Doors Pand
Electric � Plumbing � Sprinklers `Generator � Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of construction: $ �,, t]g � . _ Utilities: � Sewer _ Septic Building Height:
OWN E R/LESS E E Name !�nnName:
Address:. \Ck2t Company: E\rec nbo� W`�t�lC..
City: FOL State:V-1 . Address: 1 t �- � kA%�-:A&�A
Zip Code: 3XAq%3J Fax. City: ETI t � le Stater
Phone Na. 11 gj-* 'SR 3Q 9%1 Zip Code: 39Fax: ,'%2►--Aiai -144&
E-Nl a i I: 5ghmum?42n a0N . WM Ph ane No r1�
Fill in fee simply Title Holder an next page � if different E-Mail%pY�teS��'u�01,M ,Qo�..7
from the Owner listed above) State or County License_ _ �C. I�CDC] P�
Y value
of
construction is
2500 or more, a RECORDED Notice of Commencement is required.
If value
of
HAVC is $7,500r
more,, a RECORDED Notice of Commencement is reui red.