HomeMy WebLinkAboutW Bouchard ac change out permit app pg 1All ::j]· 'iX. MUST BE COMPLETED FOR APPUCATION TO BE N.Xf.PlfD
Date: I 'j:Z, Permit Number: --------
~'"!.: LU:GLI!s · · --"' ·o Jl I ... ,,-'
I! Building Permit Application
Planning and Development Sen/ices
Building and Code Regulation Dillisian
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial -----
Phone: {772) 462-1553 Fax: {772) 462-1578 CBOG Funding ___ _
PERMIT APPuCA110N mR: A c. CJwi _ oV:t-
PROPOSED IMPROVEMENT I.OCATION: ·
Address: __J~_JJ-f..U.!...!_..L.J'.J,u..'---,-J::...lll.:.1.L.!...~~, l:c!fi..=G!:::&:__::::o!J-42..:'.!5::'...!JL..i.:::.j~~.!:....!.!~::::!..:.!.::ULIL.11!.!4-
Property Tax ID#:_______________________ lot No.~,,,~~¼=--~
Site Plan Name:_______________________ Block No. __ _
Project Name: _____________________________ _
I DETAll.EO DESCIUPTION OF WORf(:
1,u),11::1 10 kw heat.
New Electrical Meter ____ second Electrical Meter _____ (Affidavit required)
I CONSTRUC110N INFORMATION:
Ad,:nal wort< to be performed under this permit -check aU that apply:
_Mechanical ft/l _ Gas Tank _ Gas Piping _ Shutters
Electric _Plumbing _ Sprinklers Generator
Pond _W"mdows/Doors
Roof ____ Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction:$ 5 / 0 0 . DO Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/lESSiE: CONlRAtroR:
Name Name:
Address: Ile V'l({),_, Cruz If?; Company:_J211ll/ll,~4-LL.!!__n{U:!!!~~!£i..:-
City: tOCb Pi't((Q. 1 State:...&, Address:_j21J~.J!C.::.Wfil~LW/l:!!.....!:!~-
zip Code: 3 '-Kl5 1 Fax: Citv: tOf\;:: Ptt.«.e State:
Phone No .. ______________ E-Zip Code: 3tl'J51 Fax: _____ _
Mail: PhoneNo1:1,--4<,1-4-t--tl
RH In fee simple Title Holde,-on next page (if different E-Mail r,o ~ ~,i,hrfl). Cl}'\'\
from the Ownerlisted above) State oreoudtv License C.OCl&(31X £,
lfvalueof-.sUuctionis2500armore,aREOOIIDEDNotic:eofCo•meolQ!nert'>--,ed.
If value of HAYC is $7.SOO or.,._, a RECORDED Notice of Cocm11ecement is reqaired.
I