HomeMy WebLinkAboutBuilding Permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 -;Lq, ;-X Permit Number:
91`Lr. Li~rG(11�
' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: rnecll ► ' I
PROPOSED IMPROVEMENT LOCATION:
.-Address: I I iq Oe4 le6 6JV Ce f T J V 5oa- 501- r 346- DOQ -
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: i
Cc 5
i o 1C IJ 6,tcr I ' e -Gr ) i -
New Electrical Meter Second Electrical Meter,
CONSTRUCTION INFORMATION:
(Affidavit required)
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: $ 5Iq QD . Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name R. i' wa !
Name: Q 0 ylCt cor � \
Address: C GS 6 IVY,
Company: NAA 9 A,4er r,:Ses
Address: I a- SE cc
City: fo& 5+ Lc-C. e_ State:
Zip Code: 3 QS' ;- Fax: 33S,3310
Phone No - a3g4
E-Mail d F`r'St5 dd _
City: T_kw5eA kaac.!�L ---State: -F1
Zip Code: 3 H9 $ 7 _ Fax:
Phone No. 5$ • 31.3 - S'113 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License GA&C IAY5 5$
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.