HomeMy WebLinkAboutScan_0010.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l - -)'7 -')- 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 C$DG Funding
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PERMIT APPLICATION FOR: r4\tC �LI.GA..�
PROPOSED IMPROVEMENT LOCATION:
5 Iv
Address: y e,5 91v J:a( #W' 4.50 - 5 01 . d a` S'- 0.00 - 6
Property Tax ID #: Lot No.
Site Plan Name: Block No,
Project Name:
DETAILED DESCRIPTION OF WORK:
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5 k k eo g-r l i ke- fmc I' e
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
T Electric —Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Ao%4-koYt S vnr,
Name: QiItic-e K C or r A
Address: s� 2ie s �3iy
Company: 0)-r~ +r,C r't5e5 :[:AC -
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City: State:
Zip Code: 3t{ ' �I Fax:
Phone No. 'i-72 d` 7-10 6 6 Z _ E-
Address. 1X9(o 5E :r^J4AS+Jrl'jq 6('J
City: P Sf k e, State:
Zip Code: Fax: 3 36 - 3310
Phone No 9 1- X3 q 4
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail dJd -'e A Q- otedd. G�/N
State or County License CMG / ;t qg q!�g
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.