HomeMy WebLinkAboutBldg 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: �p
PROPOSED IMPROVEMENT LOCATION:
Address: %, 22 6= &J.-Qk Df- fA CV'Qt1Uf 4 1ELRH Cl is
Property Tax ID #: 05c " 50*5 - OM - QM A o Lot No. 5 3
Site Plan Name: Rlnrk Nn
Project Name:
DETAILED DESCRIPTION OF WORK:
V Ck \LA -
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
V Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ t��QO
00
Sq. Ft. of First Floor:
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer „ _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company: v
n
Address: `�� A'S• TX6_t n 1Gkyj-,c Or.
City: �F' )!a 'p exc 4=! State: ].,
Address: " L d- I W11+103
Zip Code: &L1�1�j oc Fax:
City: State: FL.
Phone No. Lim - (mil E-
Zip Code: Fax:
Mail: Lxv@,�scmw.us
Phone No'A!S D- \ALAS -LQz%-0
Fill in fee simple Title I older on next page (if different
E-Mail ( O)
from the Owner listed above)
State or County License I-',JC J5
IT value oT construction is zsuu 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.