HomeMy WebLinkAboutBuilding Permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ) - I q- a-�L Permit Number:
LUTCM
Building Permit Application
Planning and Development Services t/
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: jlt��h�ni'Gw
PROPOSED IMPROVEMENT LOCATION:
-Address: (01 0 j 5, dL �r # ���' P fG-� Zd .5�i " 05_,ojyq- ocu
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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eem 5+- G,o I _'Ie 1 t'+ 5 s4e M 10 k A) hem r
New Electrical Meter Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check
all that apply:
_Mechanical _ Gas Tank —Gas Piping
Shutters W indows/Doors
_ Pond
Electric — Plumbing „Sprinklers
_ Generator _ Roof
Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: 5-5�0 0 • J Utilities:
—Sewer ^ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Iry � i'rr Pic+ Z
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Name: 66nc•t 9- 4,r 6
Company: 0 0 a 0L !� er r"iSGS
-TAG
Address: 10101 5. 0 44 A n Or
&f d_1 State: -C- I
Address: 1 S E
tar u
City:
zip Code; 3 Y 4 S7 '1 Fax:
City: ro r4 S+ L)AC'k-
State: `Ff
Phone No. 51$ - `IS) - 450 4
E- Zip Code: 3N5S d Fax: 33Y'3 1
Mail:
Phone Na 3Q343Y4
d en+er ri St S@ 041
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Fill in fee simple Title Holder on next page (if different
E-Mail 1661.
from the Owner listed above)
State or County License GM C Xg qgS
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of FiAVC is $7,500 or more, a RECORDED Notice of Commencement is required.