HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ;L - 16 - Z-1 Permit Number:
'y Building Permit Application
Planning and Development Services e�
Building and Cade Regulation Division Commercial Residential %0
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: ry\ecka/L•CAJ
PROPOSED IMPROVEMENT LOCATION:
Address: J�3�9 N e,i'I S 91vd- Parce -*yS0;L- 5`61 l0;'L41-060 -1
Property Tax ID #: Lot No.
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
5
-- .�
10 V- h fo,r ' k
New Electrical Meter
Second Electrical Meter
(Affidavit required)
Block No.
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank — Gas Piping — Shutters
_ Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ '1"• Cr'*
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4,6
!Name:
1Z co i n
Address: Tv 1 e s 61v
Company:
D ddd 16 Mc en:583
City: �1 A 13QXd- State:
Zip Cade: 3 y cf S ? Fax:
Phone No. f-5. 51)-0 - 400
E-
Addres
1
tXC110 SLr
City: Q (
Zip Code:
Phone No
S" Lv�c4 e- _ State:
39 q'51)- Fax: _335.3310
-1-3
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail d Cj1'1'$-f' l�i� S '3 a •�l�h
State or County License TU14 C 1a 4q9 S19
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.