HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 -77- �L- I Permit Number:
UUN0 .
Building pp 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 CBDG Funding
PERMIT APPLICATION FOR: ilner..c.r�c a✓i
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
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:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name W T �
Address: 511 0C:-{$ [ f5 161,4_
L.
Name: 4.vC Corbin
Company: v�d f+S�$
_
City: D fen ble4(eK _ _ State: _
Zip Code: 3M 151 Fax:
Phone No.^
E-
Address: 1 ;L q 1O 51
City: P
Zip Code: 1.
Phone No
E-Mail en�'�f
Fax: .335
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State: I
33 f0
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License G11�G
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of NAVC is $7,500 or more, a RECORDED Notice of Commencement is required.