HomeMy WebLinkAboutBuilding PermitAll APPUCA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1JI 11 PermitNumber: --------
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Planning and Development SeNices
Building Permit Application
Building and Code Regulation Division Commercial Residentia I
2300 Virginia Avenue, Fort Pierce FL 34982 -----------
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPUCAT1ON FOR= A c, Chttn
PROPOSEDIMPROV£MENT.LOCATION:
SI
Property Tax ID#: ________________________ _ Lot No. ----
Site Plan Name: ________________________ _ BlockNo. ---
Project Name: ________________________________ _
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter ----------
I CONSTRUCTION INFORMATION:
A~nal work to be performed under this permit-check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Roof
Pond
Electric _Plumbing _ Sprinklers Generator ____ Pitch
Total Sq. Ft of Construction: ______ _ Sq. Ft. of First Floor: _________ _
Cost of Construction: s _3~Z=OD~-00~----Utilities: Sewer _ Septic Building Height: ___ _
OWNER/LESSEE: CONTRACTOR:
Name l?, · ·· J · • ?>l.i rt N t..l•A---1 f:. ~ ... , ame: • , •
Address:13Q$ ui.,(jfo1~CUS tU, ~:::::~~~~tr~ ,1,w~ City: ro(.\,-"'Dtt[ll-State: ft,,
Zip Code: ~'5 I Fax: City: i:oit £iuu.. state: R...
Phone No. 112: • 2.J.H -J..ljJ l Zip Code: ~I Fax: 11'--J.lllc:.313-:/..
E-Mail: Phone No 1'.]l---LI~ I• ~ 141
Fill in fee simple Title Holder on next page ( if different E-Mail boyJ.o.()J! e. '-('t'hOQ. l'all!
from the OWner listed above) State or County License CAC I 'i I 'ill~ VJ
. . . 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.