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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I Date: FO MUST BE COMPLETED FOR APPLICATION T0 BE ACCEPTED Permit Number: sL+a I,uLeuLE BH; __ - \11 +. \J £,@ R I ® ZS ri:i Plann.Ing and Development Services Building and Code Regulation Division Building Permit Application Commercial L/` Residential 2300 Virgjnja Avenue, Fort Pierce FL 34982 Phone: (772)462-1553Fax:(772)462-1578 CBDG Fundin8 Site plan Name: ~/pr BlockNo. Project Name: DETAILED DESCRI-PTION-OF WORK: e-Ff - 4- 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 Electric Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: S Shutters Windows/Doors Pond Generator Roof Sq. Ft. of First Floor: Utilities: Sewer _ Septic Building Height: OWNER/LESSEE: A ` CONTRACTOR:\', Nirme FrTal\K_ Hnrre_+I-I ,Narme.. K(lY\ lu{/Son Arddres;. -qJffFD -5±;Orion br . unJ /531 cflmparny.`` n p`/ J`` D I .. /-`.r^rddre!ss..ir>9i^KUiY:ieI-ftAJV cj+rty..-d`¢fl -' ' shale..Ja, 7Jlpc-nd:.3! 5: Fart.c#Dcode.. -at Fen.7jinrtwf JneNrJ. C/ /4 '8f J4-/z)24D E= •pwidilJ.. N/ r4,Tlrvifne"f. i`79i: f pc/3--&{bo / Fill in fee' simple Title Holder on next page (if different E:Mi+I ^rpn / A i)fNf a, OIif)ff I I. CffYlf\ stateorc5Tunty-'Lic:nsec4f_fflf_.©3.35-74:,from the Owner listed above) lf 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. E simple TiTLE Name: ueLRER:_ Not Applii:=bie Phone: ueRTcaGE€Outpaey Name: BO«"pe Name: Address,' •Cenou¥: Phone:0==I-certftytha{noverkorj8sta«ationhasrmmenedpfortotheissuaneeOfapermit. fr¥¥ri-riE=±rF=ae=£.T=rfe¥ Not`Applicable State: _fret Applicable `ryock and iflstallation as indicated` &ti+:u!:::#pc:gn:¥¥¥#fe#rfu¥E=#¥meRE|gHELifeiffiJt"i#£b#ifegife:#ifehoifeha:n¥#,##Sfy%#hrfub%usruech :::=n:£::a£°£f*:Bpnrs*a;g£5s,r#ueeedfa¥jikde*aeyndass{=¥tdrth#t;nflern¥gis.performthew°rk Thefollowingbeiidingpemitgivica€-fcasaeeegivfronunde]ro.ngafu#cor"TenqFrevieev:rcrma`dditioris, accessorystrtyctures,svrfunggivs.ferteestoife,see,screen8comsa-ndaccgaeeyueestoanotherron+esidentia1useI-|Jt--I- 'I ,-.--- _. _ _ _ pqsrED on Tvs gce siTEI-YtxJR: Sjgrtature of Fptsr -cnthL I YouI- o`mer/iessea7coBtraeeor:oritrae±€>+±Sl:*ipEaiiajfigi5;= STATE cH: FunDacourmOF noutedge€:iiebe in.e ±Oa'. giv Name Of person rna king sfatenen{. Personallythown±±ORProdLndidentfficz±iha Type oS !dentfficatiori Produced e-*esRE. COUNTER REVIEus DATE RECEIVED DATE COMPLETED -__J_` i . i.+ HT "y RI5utT. " yon pAynenf- nrsT BE RecoimD ae=T±e±±cusunT •IrATE OF FLceEm cOLrm es #Lngyi=sinstrQm T}owledged before me EEREEHFEEEIEfflE=EIEEREEE Per§onally Krioun ± OR produced !dentificaeion rtype of identificaienPredueed_ [ftyTfaiiE Same Of Florid . i Commission t I-i--_mafunaepea!}¥','*.IEBREi7,ae I-i.?visoB PLANS :-I. -`'. - :` -. -.-`sE~;„. GRoVE i '-6FTjq -I !un • tA '!-URTLE •,` `E?flew REVIEW'REVIEIA'REVIEW REVIEW i I