HomeMy WebLinkAboutScan_0035All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' �"I Permit Number:
D
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: mo A,&nfCd,
PROPOSED IMPROVEMENT LOCATION:
Address: (-- S o N e-!t e5 Bud, ParC,° ( :Cd- * `DSO )- -,5'01- 7 - Ud d
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (IsQ d . o U Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5tA<6it,6,ItLL—C
Address: I21-50 Oektt5 Elva
Name: UaInCt i A
Company: Dookok Epp J15eS �rp G
City: 5G1154 6c" —State: FI
Zip Code: 3 wg y 1 Fax:
Phone No. 60 ID - 3y$ - 1 136 E-
Address: D-91 b 5*1� SA AAAD 4L% dbi
City: O r5 i L vLc,, 4E _ State: tr 1
Zip Code: 3 � 9 5 7- Fax: 335 , 3310
Phone No 39 S' a3q
E-Mail hd d we Corr,
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License e M C I ;L
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.