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AIIAPPLI BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date
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Building Permit APPIication
Ptanning ond Development Services
Buitding and Codd Regulation Divisian
23Aa Virginio Avenue, Fort Pierce FL 34982
Phone: lllzl +az-t553 Fax: (772]' 462-L578
Commercial Residential Y
Address:
Lot
Property Tax lD #:
Block No.
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply
-Mechanical -
Gas Tank
-
Gas Piping
-
Shutters Windows/Doors
Roof
Pond
PitchElectric_ Plumbing _ Sprinklers _ Generator
Ft of Construction:I -.t
Sq. Ft. of First Floor:
Cost of Construction: S Utilities:
-
Sewer * Septic Building Height:
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
t C Ic>PERMIT APPLICATION FOR:
lf value of HAVC is $7,5O0 or more, a RECORDED Notice of Commencement is required'
t
Total Sq.
Address:
City:
Zip:
-
Phone:
MORTGAGE COMPANY:
.
Not ApPlicable
Name
NotEER:E
State
zip:
Name
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-Not
APP|icable
City
zip:P
BONDING COMPANY:
Nam-
Not APP|icableFEE S!MPLE TITLE HOLDER:
Name:
Phone:
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#
April 09,
OR Produced ldentification
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STATE OF FLORI DB\Lr.<-\a.-
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Online Notarization
2020 by
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Name of person making
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Type of ldentification
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Personally Known "/ oR Produced ldentification
Type of ldentification
as Agent
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Owner
I
Name person making statement.
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STATE OF FLORIDA ;j+. L\cn'(_COUNW OF
nd subscribed before me of
or
-
Online Notarization
2020 bythis ;33ay of
Commission No.6
(Signature of Notary Public-
P
VEGETATION
REVIEW
SEA TURTLE
REVIEW
q
MANGROVE
REVIEW
REVIEWS FRONT
COUNTER
ZONING
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SUPERVISOR
REVIEW
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R
DATE
COMPLETED