HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: <d-' ill Permit Number:
o LUTQ1L
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 CBDG Funding
PERMIT APPLICATION FOR: A\,e&&*.,
PROPOSED IMPROVEMENT LOCATION:
Address: 1 3L5 0 e-#- (165 IS I\J Arcet —zo Lisp -so f -15S;a -006 - a
Property Tax ID #: Lot No.
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK: I
0 an I Y 5{GIr Pavine _ f- ao LAn c t
-l�u r
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
(Affidavit required)
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: V
Cost of Construction: $ i Kw I
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name fVx Cif DIA m
Name:
arLCL 1E
60 101 YA
Address: 13ce t2e*lesD w
Company:
DoA I e ft+zf-
pri SeS -Tne
City: SaK State: _
Zip Code:,3� q5J Fax:
Phone No. 'f 7 -.X -
E-
Address:
City: Part
Zip Code:
Phone No
Si LL►Gie
3 k i S �L
39 S ')-3 4
State:
Fax: 33E -331 o
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail J-614P C
1"t $�S e �d� • G�WI
State or County License
1 a 4
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.