HomeMy WebLinkAboutSt George ac change out permit app pg 1.pdfAll APPUCABlf INFO MUST Bf COMPl.fTED FOR APPLICATION TO BE ACCEPTED
Date: 2/1--o I 2--Z.. Pennit Number: ______ _
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(=(.5~:Jij'. 1··~ Q !!q"l' f111,l!!!IJ, it '••¥. I.: -r:· 12-' •( •c , .. tr f.i: ~--------Building Permit Application /
Planning and Development Services
Building and Code Regulation o;.,;s;on Commercial_____ Residential _V ___ _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR:
' Address: I
PropertyTaxlD#: 1303 •2..ll-OOJ.-5-()ool
Site Plan Name: I Block No. __ _
Project Name: _____________________________ _
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTION INFORMATION:
A~nal work to be performed under this permit-check aH that apply:
_Mechanical A/l _ Gas Tank _ Gas Piping _Shutters Pond
Electric _Plumbing _ Sprinklers Generator
_Windows/Doors
Roof ____ Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction:$ 4 A-00 .00 Utifities: _ Sewer _ Septic Building Height ___ _
OWNER/LESSEE: CONTRACTOR:
Name C, • Name:
Company:.Dfll/J.Ll:1/;..k..!!_,.M~~hJ~~-
City: --1'.-.lill~~LU!.afi. ____ State: Address: ...!<'.l=...P.-l:.IM.ILL\<!11ll!i,_,Jt::,UI~!.-..:=.:..· -
Zip Code: '33 Q/J '1. Fax: -~f"=-:Q,._____ Citv: {,Qrt: fi'tfU State:
Phone Noltwl,l\t • Dor tefl. St-, Giorq.., E-Zip Code: ~ l Fax: _____ _
Mail: g(,o. [p3q. Oifi.r PhoneNo7l:),-4<,1-41,,1-1
Fill in fee simple Title Holder-on next page (if different
from the owner listed above)
E-Mail ~o~lutet-,j&..b@-OOY'
State or eoulty License C.l\l lg ( Kl X ft
If value of construction is 2500 or more, a REOORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.