HomeMy WebLinkAboutPermit Application pg 1 .pdfAEI APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )-pi G��', �c?1 Permit Number:
� Lie L �� Llre.
:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential v'1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: A e, 6)-)64c--F_ Pyi4 c
PROPOSED IMPROVEMENT LOCATION:
Address: 1 1 5W. Z8cnZ f'-
Property Tax ID #:
Site Plan Name:
Lot No_
Block No.
Project Name: Fs Q Lk I F_ L,---.--- _
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 Tanis —Gas Piping — Shutters Windows/Doors Pond
— Electric — Plumbing Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `4 010 13, 00 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Ru an 't kehece4L__ c i.c.i VP..
Name: "t64)mas
Address: j_� �. t�=-� E'bb �1�
Company: fZL,, , - NA)
Address: 4 Lr 6�
y n CIS f G,ice• a j
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City: R> r#' ST L[�['r! _ State:`V-L
Zip Code: 3�,A Fax:
Phone No. -7-7,2 - 3�)3 j 'i I E-
City: _ tLk0_r4 State:
Zip Code: —�7,q 9'S Fax:
Phone No _'77-)L - -_-'2 L,0 - JT)-7 9 Ski . 309 - 4191 f
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Fo"r W nds
A
Stat ' r County License
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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.