HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ') _aU Permit Number:
SM., L Luck " ; .
Ui I
V �� _ 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
PERMIT APPLICATION FOR: Iso FF /
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
1W
I —(P/'f -W
Lot No. 15
Block No.
New Electrical Meter Second Electrical Meter
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: $ _� �� Utilities: _ Sewer i Septic Building Height. 1-5
OWNER/LESSEE:
CONTRAC'T'OR:
Name
Name: !
Addre
Company: 1n
�����lU����
i�- 5 G
City: C. -Q_- State: L
Address::
AAS �
Zip Code: Fax:
City: uL/I -iii C) �
State:Ft-
Phone No. -' — SZ 9qZip
Code: 3 ` -'5
Fax:
E -Mail:
Phone No L
Fill in fee simple Title Holder on next page (if different
E-Maila
I 0 d
from the Owner listed above)
State or County License
it value or construction is cbuu or more, a KbLUKOW Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
__2U b")' ki q 110 I a°