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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
S `n LUCUr5-;
�f-a°' °` Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
CBDG Funding
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Lot No.
Property Tax ID #:
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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 — Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i Name:
Addres . °< Company:
City: Stater Address: J
Zip Code: Fax: City: State:
Phone No. 7 ":� [s� ��!Ml E- Zip Code. Fax:
Phone No
Mail: , c
C7b
Fill in fee simple Title Holder on next page (if different E-Mail
State or County icense
from the Owner listed above)
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.