HomeMy WebLinkAbout1Diane-poland-permit-application All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 )I a� Permit Number:
(-L P UL tiR
5,.1
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: l u 5cAjyi LL-rje! ' FL 4
Property Tax ID#: 3 S - - 6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
-1
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 lumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: Z
Address: Company: )oi _
City: U State:FL- Address: S�� N le t km (° -me
Zip Code:3>LA Ct%-�o ^� Fax: City: "r4 Luc W State:
Phone No. 7� - r�ao`� SS�U E- Zip Code: 2,�,Li q '6-C,-, Fax:
Mail: Phone No -7?a- 2 - S57 b
Fill in fee simple Title Holder on next page (if different E-Mail L +
from the Owner listed above) State or County License
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.