HomeMy WebLinkAboutScan_0001.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )L " ;L Ll` �_;L 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 Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
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PERMIT APPLICATION FOR: fr\.e I � -1
PROPOSED IMPROVEMENT LOCATION:: I
-Address: 6 ,q s7 Ne.-(f to 5 S8a-' 0 l ' C� �i ` UO[� �' U
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
i DETAILED DESCRIPTION OF WORK: I
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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 T Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 • Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name e \P'Dr l
Name: anoe fk COt ;A
Address: vi,5 NomeS g(V
Company: Q01A Em+ef rtAs �G
Address: t 7- q 4 S 19* 15Fri",L1 9('J—
City: d 5i' (--•kG Stater
Zip Code: 3416"A Fax: 3.5.331 O
Phone No
City: T'e f%S 11 UAC'k __ State, 'FI
Zip Code: 19041 Fax:
Phone No. Sd �� - I E-
Mail:
FIII in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail 0►U 1At1\+e'r (T(*SeS @ &od�l. • C'ow
State or County License CM C ( a-5 99 5g
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.