HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 41 - a' )- Permit Number:
ikll �44_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential
PERMIT APPLICATION FOR:�����
PROPOSED IMPROVEMENT LOCATION:
Address: 1305 IN e#-ItS S �v �Cc�ce� dl yS�a • 501 . I H9 - ODO �3
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
0 IA,, t 3` 0 ! 5
I D K w I i �--e `Fvf li .I.
0
°re 5--
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: Sq. Ft. of First Floor:
Cost of Construction: $ gg00 . Utilities: _Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name R r^ x ,, Sen
Name: a Ct_
Company: a0 9A+Cr ,r`iS15 =AC
Address: 12- rA( �l+J
Address. 13 ' 9*Sf-1#1e.5 Elva(
City: TtAuit &'at State:'-{
Zip Code: 3 N q5:1 Fax:
Phone No. E-
City: Pa rt' S t LA. -A_ Gt'e -- State:
zip Code: 3g95 a Fax: 335", 33
Phone No 31I5`d - 2.3Y Lf
E-Mail '} d) -- �M
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License GEC / �y 99 5Z
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requireda.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.