HomeMy WebLinkAboutPERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
tX �
LF ' ° �;: �' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: f' edA0.ekl•ea..t
PROPOSED IMPROVEMENT LOCATION:
Address: f 3 -7-7 NO ie-5 NJ ?A ce `( �Cd. _i:�r 45).. _,5v (- )S6q- 006
Property Tax ID ##: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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5 K w h e. + I i- k_z ` l; ke'
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ _ 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: $ 6 300 . 0' Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 0 k^C I I C. %IA.^ Ce-
Name: VarrtCt fz, Corbin
Address: 031-7 Ot*WS 13I4
Company: od( En+cr !'1_StS -_VAG
City:�a1'sen ey-4- 1 — _--State: f5i
Zip Code: 3�55 7 __ Fax:
Phone No. 34I- 1 65, E-
Address: la t 6 :5 G ZAA&S-f
Pai 91
City: e0r+ S %-L ol't
Zip Code: 3`1gS' . Fax:
Phone No 3R -a3IfI
State:
3 3-5'-33I o
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail 0"e ki-cr r;SeS a Jo4J Gorr%
State or County License (' C fatM51
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.