HomeMy WebLinkAboutapp pg 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1.1
Permit Number:
1�`�o
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:
PROPOSED IMPROVEMENT LOCATION:
Address: "11,A317 S. QCeCA_nIc 0 `►►9 -9
Property Tax ID #: �J22- (p03- CEO ?,O - 000 - 9 Lot No.
Site Plan Name: So -'a Block No.
Project Name: -YPc'QPs \Ca O
DETAILED DESCRIPTION OF WORK: I
\�_v Sgez \-\yr' c s}cM
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:
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Cost of Construction: $ S\lna.o0 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name,erk0 V oxn.S
Name:
Address: � UP 5W \Lk'k"% c-4r
Company: \rc-
City: �\kCAN�� Stater
Zip Code: 33\45 Fax:
Phone No. __A SIo-SSy - a -1a 9 E-
Addr ss:,,i}r13 Sv)% tn, % 16Y\_ %2
City: \ State:.
Zip Code: O Fax: '7IZ-Z3Z- I I I
Phone No -112- 232 - I I q
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 1 h i� �flo(�iri nG Gorr
State or County License CAC 05&508
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.