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All APPLICAff 1,N8qWLqST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( fi
Date:�rEude Cniin y Permit Number: cut) CA
Permitting
940A op...p TIS Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Aff Rae74h0*n Likes' ID/ Avr4- St, Zocl 1�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
tea✓ o4r DYS4-1'17 d r-',n -!1114 /
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 &oof �-Pitch
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Total Sq.Ft of Construction:: 15-600 Sq. Ft.of First Floor: ".5�4 p0
Cost of Construction:$?T�,do Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR
Name for 6�/ Name: 1.eao7 ef,- /fact ®/-
Address: 0014n-&-ko-n lVes Company: 7r• -e ro`✓ri dfae4':"2 IA16
City: • ;, Loe-it State:A6 Address: 3g_YG S®U-/-A 14v-G
Zip Code: 7 VV6 Fax: City:�Az-.1 II&S State: s�L
Phone No. Zip Code: 33S'/2 Fax:
E-Mail: Phone No 813 `7/- `4f4 s7
Fill in fee simple Title Holder on next page(if different E-Mail /--1'763[y Q o/ e47"%
from the Owner listed above) State or County License 0C4�' ✓9���
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.