HomeMy WebLinkAboutBruyere AC Change out permit app pg 1.pdfAll APPUCABlE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPIED
Date: ll ( u\u Permit Number: ______ _
t}\l:J-~f~L~~_:;~ ~t'.)'I ~ ~ Yi-4%~1-·._ V f?@fu::V-.,, ~ ~-:-.-~-·~-.. Building Permit Application
Residential _ __,._/ __ _
Planning and Develapment Sentices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial ___ _
Phone: (1n1462-1553 Fax: (772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: A ~ CM,.
PropertyTaxlD#: _____________________ _
Site Plan Name: _____________________ _ BlockNo. __
Project Name: ____________________________ _
I DETAILED DESCRIPTION Of WORK:
New Electrical Meter ____ Second Electrical Meter, _____ (Affidavit required)
1· CONSTRUCTION INFORMATION:
Additjonal work to be pe1 l'ormed under this permit-check all that applv:
{Mechanical A/C. _ Gas Tank _ Gas Piping _Shutters _Windows/Doors Pond
Electric _Plumbing _ Sprinklers Generator Roof ___ Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction: $ ".3 g 00 .OO Utilities: _Sewer _ Septic Building Height __ _
Name
Address:l~&@,t II= (i
City: 112(-l~ I tf (,_l,
Zip Code: .1!J12 I Fax:
PhoneNo.i&;/i&3-3itl3
State:
Mail:. _____________ _
Fill in fee simple Title Holder on next page flf different
from the aw.-listed abcwe)
CONTRACTOR:
Name:
Company:__QD!/JL._fi-i,.L<..~~~~,--.1! ~t-=--
Address:J2(£1fLJ!cli.Yn~LI~~~'...__
City: f1!r1:: Pit«e State:
E-ZipCode: .~I Fax: _____ _
Phone No :n ?--4<, 1-4-f * \
E--Mail ~'/~~~fOl@-C6}'l'\
StateorCoudtv1.icense CA(:Jg(ltlX ft
If value of construction is 2500 or more, a RECORDED Notice of C.Om1nenwnent 4 required..
If value of HAVC is $7,SOOor-.e, a RECORDED Nnceof C •• c•-is ,equired.