HomeMy WebLinkAboutCHRISTIANSEN RD.All APPLICABLE
Date: fol
IVFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34952
Phone,: (772) 462-1553 fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit umber:
Building Permit Application
Residential V
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Commercial
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PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
22AL %,=ft 5�almmhnd )_ 7t; 0... C)CC — rl Lot No, "11
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter,
CONSTRUCTION INFORMATION:
Affidavit required)
AddIftional work to
be performed under
this permit — check all
that apply:
Mechanical
GasTank
Gas'Plping
� Shutters
electric
Plumbing
Total Sq. Ft of Construction:
Cast of Canstructian: $--------�_��. ��
Sprinklers
Generator
Sq. Ft* of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: Sewer Septic Building Height:
OWNER/LESSEEO,
CONTRACTOR:
Name �
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Name:�Drncs E
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Address. 9�`j(a- GOriS&an
Company:
City:
State:
Address: O�C\ \X�
Zip code: 3�-�tQ$1 Fax:
City: t"� - �2.rC9�
state:
Phone No.)N).-
Zip Code: PQ2�
E-Maille
Phone No
Fill in fee simple Title Holder on next
page if different
E-Mail M
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from the Owner listed above)
State or County License �G�-.����i�
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.
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