HomeMy WebLinkAboutScan 3All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 133I08tawl . Permit Number:
S`1i� 1 I- M .....
> K � Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: BIg0 & a C. 9f)yJ S(►►ni oCif yl- 314952
Property Tax ID #: Lot No._1_
Site Plan Name: Block No. I
Project Name:
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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5 lw no
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 2490 R (JJL L PX 'lrl G%
City: 90& Vint W(lC State: FL
Zip Code: cig52 Fax:
Phone No. �3 �( { - 0j149 E-
_
Company: Ets qi, 3 �� LLC
Address: ) a6111 �i_
City:y {Yl, fctch State: �l
Zip Code: _`319.6 , Fax:
Phone No l l2 - 519 - 0
E-Mail_ MiJaV 8a P IfJG}QSa1Y Gild 6& • COM _
State or County License CRC 12),05cii.
Mail: I1SCCtGQYftI'10�� �. c�c�rn(i` }-11f;�-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
VQ Uu v%AJIIDLIULAILPf1 1b ZaUU or more, a KCwKUtU Notice oT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.