HomeMy WebLinkAboutDziedzic permit application pg 1of2All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- �O Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTax lD #: 7—_ 5Q —00 \ -ooc) — Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 _
Electric _lumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7'C:)c) Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNERAESSEE:
CONTRACTOR:
Name rC
Name:
Address: Z "1 <.t
Company:
City: C +r J� . Ll tC L _ State: L
Zip Code: Fax:
Phone No. 12_- C�Zn�QT ice, E-
Address: �C� i try
5
City: P CA- uc I e—
Zip Code: 3`aG _ Fax:
Phone No D —1
State:
Mail0
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail i tC:i r»r 1C
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State or County License
•• — -- v I--- -,%.7VII ra caw V1 IurG# a KL%.VK1JtU imotice OT lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.