HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V - � '[ - 0-�- I 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 CBDG Funding
PERMIT APPLICATION FOR:
n1eC, kan[ Ca.
PROPOSED IMPROVEMENT LOCATION:
Address: it 33 Oe_RleS awl F0.�C2( iky `150?--sw, 13;to. 0
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
a nee v sct 3 +o n 14 Peer Rk-ce y, ^_m,+ PK rv-J sa ), -f 6k5+ens,
5 K w heat I k e --F r 1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters Windows/Doors
Electric —Plumbing _ Sprinklers _ Generator T Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
da
Cost of Construction: $ 7 a00 . 1Utilities: —Sewer _ Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name .e5 L A C.k
Name: Q&OLC4. )Z, r' �Ir6 r A
Address: l ( 33 0 e- 0 5 IQ 1,
Company: D oJd, EMec pr'rS¢K
T;-,C
_._
City: _T4i/C ,In �Gtr State: _
Zip Code: _NCI0 Fax:
Phone No. Sd - 3G, -0013
E-
Address, l?-�i(a SE � I,cs�i7%�{
City: `Dl` t St Lt�C.i C
Zip Cade: SggS` Fax: 33s
Phone No 3gB'•:13 V'
E-Mail &JJf_/ f'c� �1
State or County License CAk C ) a JRSS9`
�(Vd
State:
-331D
• Ga
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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.