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0
All 0r{&Permit Number
Date
UUGNE
Building Permit APPIication
Planning and DeveloPment Seruices
Buitding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: lnZl qaZ-*53 Fax: (772| 462-L578
Commercial Residential
Address:.-l
Property Tax lD #:1
-5c;l-oZ oc)o-q lot ruo. i
BlockNo. e 3Site Plan Name:I
Project Name:
lt t,
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
-
Electric * Plumbing -
Sprinklers
-
Generator Roof
Pond
Pitch
Total sq. Ft of construction:Sq. Ft. of First Floor:
Cost of Construction: $6t>rt Utilities: -- Sewer
-
Septic Building Height:
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required"
PERMIT APPLICATION FOR:C I
lf value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is required
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Not APPlicable
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FEE SIMPLE TITLE HOLDER:
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ill!il
tl
of
STATE OF
COUNTY OF
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Signature Notary Public- State
Commission No.GaL{ay((Seal)
re of
STATE OF
COUNTY
and subscribed before me of
or 0nline Notarization
this i day of 2020 by
Type of lde on
of Notary Public- State of Florida )
commission N".bqLX rc6( (seal)
as Agent Owner
Swor! to (or affirmed) and subscribed before rne of
../ Phvsical Presence or Online Notarization
tf*
-
day of I' f , ,2020 by
Name of person making statement.
Personally Known --::--- OR Produced ldentification
--
Name of person making statement.
Personally Known '-' OR Produced ldentification
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MANGROVE
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