HomeMy WebLinkAboutAFP Permit App Pg 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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 j 1 V1u' j" jU t N S A vLLQ-
Property Tax lD #: Q Ab %oQ'9baCk)bOOy Lot No.
Site Plan Name: n Block No.
Project Name: PT P Cf\b�Uv_-_T3 R_I'
DETAILED DESCRIPTION OF WORK:
L\) VI)OU— 1-S1C�N (�N�
ON Wi�_L_
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: \ ag I
Cost of Construction: $ "1 ,1 �b. 00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name nX—_ TIN TS ` <<%k--1y `c-411-4L—.DjM
Address: (D 1 -N'3Ci-V IA ST -- : -� O D
Name: VJOD
Company: S 1LNS
City VLA IT SrateYN -
Address: L1L1gLi Sli-i C UH'y_RU_ AvE
Zip Code: 3 *--I'D� Fax:
Phone No. (C. �L1�" ��ilp� E-
City: S� UST State: R_
Zip Code:3LAQCl Fax:��a �aC�-�1
Phone
C� (� D-"11 1ml
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License ES at)D► %yip
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.