HomeMy WebLinkAboutScan_0008All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i LuLyL r
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential b-,'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax. (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 19101
Property Tax ID ##: Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
kio/echanicai _ 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: $ 2 ;a '' t Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: ' '
Name. �" [
ompany: S c s %o I
f
City: G1 —� - State:
Zip Code: Fax: cc
Phone No.i°��� ^� �� f _ -_
`Address: �
City: �G�Y
Zip Code: _ 9
Phone Na % 7 `
Fax:
3
V
State:��
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Cl'�
' ef'4 1
State or County License <!�-14/
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.