HomeMy WebLinkAboutBuilding Permit Application (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;LOA Permit Number:
- . -. .
' Building Permit Application
Planning and Development Services
X
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: I�eG►�ancca
PROPOSED IMPROVEMENT LOCATION:
-Address:,? 1-N rje-+� (e5 13 1U f kr"ce-1 � -W'f SO L SO 1- 10 q- 000 - 6"
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
VA Q,fle, 0 C'- k a. ' -fan ( (0 5e�e_ r IZ h ee 5 f God 5 11'
K w � (0ce. +;r I ke
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: $ 500. Utilities: ,__- Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 5 �h►iZ
Name: a'n(1 'e 1Z ca t'(n
Company: (700� C—�71-er 5+25 aAC
Address:
City: �� SPA S _ State.`)
Address: -9 6 S c� I lad
City: �y,9r+ 6t- L&LGt*e- State: -P1
Zip Code: 34951 Fax:
Phone No. 61 9b . 076E-
Zip Code: 3y9'S11- Fax: S3S-33 rD
Maii:
Phone No `� - 7, 4y
E-Mail O�e+�' �� SeS� COM
Fill in fee simple Title Holder on next page (if different
State or County License
from the Owner listed above)
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.