HomeMy WebLinkAboutKurzrock AC Change out permit app pg 1All~ 1f1FO MUST BE COMPlETEDFORAPPUCATION TO BE ACCEPTED
Date:~·-·nz.J Permit Number: ______ _
Building Permit Application /
Building and Code Regulation Division Commercial ____ Residential ____ _
Planning and /Jevelopml,ntSenlices
2300 Virginia Avenue, Fort Pierce Fl 34982
Phone: (772) 462-1553 Fax: (n2) 462-1578 CBOG Funding ___ _
PERMIT APPuCA110N roR: A e, CJwi _ oc,.t;t-
Address:2._2::;)il!CLJUJ..12.Wl..s.12(L,..J:'.l)[~tlUZ~-~~~.Qj!J1~~~~.JJ~~~_tµl:41)
PropertyTaxlD#: _____________________ _ lol:No .. __ _
Site Plan Name: _____________________ _ Block No. __ _
Project Name: ____________________________ _
1·0ETA1t.ED DESCRIPTION Of WORK:
tih, fvc Uki: :]Msml n,w 3 ion
12.u~ w i-fh
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTION INFORMATION:
Additjonal work to be performed undet-this permit -chedc all that apply:
{Mechanical Afr_. _GasTank _Gas Piping _Shutters Windows/Doors Pond
Electric _ Plumbing _ Sprinklers Generator Roof ----Pitch
Total Sq. Ft of Constructio~'tr------
Cost of Construction: $ J.t ioo . 0 0
Sq. Ft. of First Floor: _______ _
Utilities: _ Sewer _Septic Building Height: __ _
OWNER/LESSEE:
Name
Mait. _____________ _
Fill in fee simple Title Holder on next page (if diffe.all
from the ~Isled al:laR}
COHTRACTOR:
Name:
If value of wnstauction is2SOO or more.a R£COIIDED -of CGnnnen .ent is required.
If value of HAVC is $7,500 or-, a RECORDED Notice of Colnme, ...,_,It is nq . eel.