HomeMy WebLinkAboutGdowik - Permit Application (2).pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater: 0Z / Z`f1/,- j.C122 Permit Number:
u' Lc L�I �.,01 L
e - Building Permit Application
Planning and Development Services
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CB DG Funding
PERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:5701 eATR-U5 t4VENUE,, FpW'r pIC12-CEO FL 3t982-
Property Tax ID #: 3W9 ' 502 - OX 2- -coo- 01
Lot No.
Site Plan Name:
Block No.
,/
Project Name: Cif/� DOW IK
DETAILED DESCRIPTION OF WORK:
U-ROW 2 51M4 5WIRCD XW WM Sfh►J41l,E TD METAL,
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 _ Windows/Doors
_ Pond
Electric PlumbingSprinklers _ Generator Roof
Pitch
_ _ _
Total Sq. Ft of Construction: 1 �J� Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
J
Name
ye WIC
Name: S>*WIttt I?V"M*N
Address:5701 0T"eE yl"VE
Company:,A1114wa 49w?
city:fb9'r Stater_
Address Iff NN tilklYfAY11066
DRAvE
City: �0� ST �LIGfE
State: L
Zip Code:3C}cj ${0 Fax:
Phone No.77Z- 2JP7— 1976 E-
Zip Code: 3,1q6% Fax:
Mail: KaadOtnliK6Jgiyhotil•corv►
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
ILIV)
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State or County License CAIZA530q18
from the Owner listed above)
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.