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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Iu�2 ( )12, I Permit Number:
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c Building Permit Application
Planning and Development Services
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Building and Code Regulation Division Commercial Residential
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2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: A 1C ehCU'1C Out
PROPOSED IMPROVEMENT LOCATION:
Address: C� n22 t f n 1
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Property Tax ID 1<: `✓L� J " i 000 i QW -- 6
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)C�
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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:
11
Cost of Construction: $ `AIDQV Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
1.
Name: - OMCGS �vtr► o `S�
Company: i WHYINUW
Name_ ltYl no
Address; N�c0- Cit (C t or) Lk
City: Ft p Y& State:..
Address:51L` N W T C3f-tJ-1
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City: pS L
State: T L
Zip Code: � i Fax:
Phone No. '112 LA E-
Zip Code: 3LA LV Fax:
Phone No�2 d1� 1
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail_ WW ift1.(-(/}`1,CLCC
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State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is CeOUIfEd
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-• • •� :- �,,3uu or more, a RECORDED Notice of Commencement is required.