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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (3)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: at 1 Z- 6 1 3 g g`IraLurar. Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial YC Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding PERMIT APPLICATION FOR: a w A PROPOSED IMPROVEMENT LOCATION: Address: to g_-5 C-s 63 2 3 g 3 S 7 Property Tax ID #: oo cjd - C' Lot No. Site Plan Name: Project Name: .3€Ac IA- r-qg, .i DETAILED DESCRIPTION OF WORK: Block No. �Qnll►� i iLt_0KtJ6,rf.2 rat -`y (ntC�LC_au�:�c�f'�D"VtLCiADC, 'r7Lk-Qr-.4e„ New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: Mechanical Electric Gas Tank Plumbing Total Sq. Ft of Construction: 1 c31) , g5- _ Cost of Construction: $ l 'i , 1 41, � Gas Piping Sprinklers (Affidavit required) _, Shutters _ Windows/Doors Pond Generator Roof Pitch Sq. Ft. of First Floor: Utilities: _ Sewer _ Septic Building Height: OWNERAESSEE: CONTRACTOR: Name -Lka r_,3�, A,&oo GnLAName: Vv �. Address: _ -� y sz _ Company:y i-c- City: 12�F - t-i--+a-r" State: Gt ; Address: Ly=t44! l Zip Code: -z5q_4 s Fax: City: ­511V ;2: State: ip-t . Phone No. "2 .� - Rot-, t aO ,X _ E- Zip Code: 3 4M i; -? Fax: Mail: Phone No :2 —2 a- Fill in fee simple Title Holder on next page (if different E-Mail ea'-( from the Owner listed above) State or County License r-2 1a00 1 I &J r(p Ir value ar construction is isuu or more, a KtcUKUE© Notice of commencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.