HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater: Permit Number:
j
L-�V L�7
Lam;
chi o
Building 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:
-=- - _ -IOU,MOW-
- 4}`
Address: 0 Q P,
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
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: $ '9.C)Doi Utilities: —Sewer Septic Building Height:
IMMUNE
Low
Name
Name:
Address: 0
Company:
City: -% State:
Address:
Zip Code: Fax:
City: State:
Phone No. bZ.6) / E-
Zip Code: Fax:
Mail: qlMed W;'11 12 C 7 C0 A
Phone No
j Fill in fee simpl Title Holder on next age (if different
E-Mail _
State or County License
from the Owner listed above)
i
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.