HomeMy WebLinkAboutTheriault ac change out permit app pg 1.pdfAll APP~FO MUST Bf COMPl.fTED FOR APPLICATION TO BE ACCEP1ID
Date:~ {1.-Z-: Pennit Number. ______ _
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Planning and Development Services
Building Permit Application /
Building and Code Regulation DMsion Commercial _____ Residential _.;.._ __ _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: A c,. th4n -OU:t-'
PROPOSED IMPROVEMENT LOCATION:
Address: ~Lll.L.J~t5.l2i4-..JJM,!&....--,--.J:12J;:!~[_l~e,,~<7f,!Ce~-~~Q__;i,(X:l@:[LY!!},~S_.M~fi!JP
Property Tax ID#: __c__-=----=LLC...1<-:=---<:..£:'-><=<-f.;,,,<,.-----------Lot No., ___ _
Site Plan Name: ______________________ _ Block No. __ _
Project Name: _____________________________ _
I DETAILED DESCRIPTION OF WORK:
New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
I CONSTRUCTIOft INFORMATION:
Addil)onal work to be performed under this permit -check all that apply:
~Mechanical I\Jl _GasTank _Gas Piping _Shutters
Electric _Plumbing _ Sprinklers Generator
_Windows/Doors
Roof ----
Pond
Pitch
TotalSq.FtofConstruction: ______ _ Sq. Ft. of First Floor: ________ _
Cost of Construction:$ Ewa . (X) Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/LESSEE:
Name Name:
Address: q NW o\~t-Companv=.,t>.C~LJ~~µ~~~~fs--:--
City; 6ai Pot!YZ~ Blach State:£_ Address:-""'=-"-'-_._...,....___"--'"""'"-"'-_;__;;'---
Zip Code: 3.30 tr Fax: __ ,,--____ C-rty: M: Pruu State:
Phone Nodintaf:: I en 1btdaJ,L-{f E-Zip Code: ,3ia) l Fax:------
Mail: 112-· i'l~ · ;[(pqCf Phone No:tJ:)--41,1-4-t.it I
Fill in fee simple Tille Holder on next page (if different E-Mail loo~ f_t.M, ~ f/A.iu@ • C,m\
fromtheOwnerlistedabove) StateorCouJtylicense CAll&l31X ft
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 Nolke of CommetlQ!lllf!llt is requited.