HomeMy WebLinkAboutScan1294All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
I _ 1-1�- 11
Permit Number:
b, r l .. ,
py Building Permit Application
Planning and Development Services Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR: rAcd\GAiCA
PROPOSED IMPROVEMENT LOCATION:
a Address: 1 ."I'
Property Tax ID #:
Site Plan Name: _
Project Name:
DETAILED DESCRIPTION OF WORK:
- 4-oln 15 ee
c.�rC aR� to Cam. ►'v
rZi6ct,+ian
11
_5Q1- Iql_ o66-3
Lot No. —
Block No.
Same �I.I-4� r✓ta+
New Electrical Meter
Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
:iteenn GO►�ol�°NS�n
M- k AA I43b l
5-k \0391'7d500`4
Additional work to be performed under this permit- check all that apply:
Gas Piping Shutters Windows/Doors Pond
Mechanical _Gas Tank g —
T Generator Roof �� Pitch
_Electric _Plumbing —Sprinklers
Total 5q. Ft of Construction:
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
Cost of Construction: $ � 0 —
OWNER/LESSEE:
Name 't.Afi
Address: (1R 0 e-411e5 '3$J
City: T r 0.� Stater
Zip Code: 3 qq Fax:
E-
Phone No.
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: A c �' Cor
Company: T
Address: SE 4,,eg-k 'o►( City: Statt
e: EL
zip Code: 34 qSa. Fax: 3S 3 I D
Phone No 3� ' -3 H y
E-Mail �d �.�n�@(' I'iS °C d� G6►'�
State or County License G P\C, 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.