HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
PROPOSED IMPROVEMENT LOCATION:
Address: ` �\1\t D VA �
Property Tax ID #:
Site Plan Name
Project Name:
DETAILED DESCRIPTION OF WORK:
L7
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Lot No.
Block No.
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: $ i t ��0 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name (�, WI
Addres $�_, _ _ C1 tit uY1t O►n
Name: In wv
Company: Q.4L ! I
City: b a State: FL
Zip Code: Fax:
Phone No. E-
Address: [ 9 �Xk)
,�I +
City: 1��C,s Ct e State:
Zip Code: 3 Y 6 Fax:
Phone No 7"22 —) -77 _ OO(J
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail we C,C 1 010 - ONO
State or County License C--C N19
V0 UV= UL-UlIbu ucuun 1b c:)uu or more, a 11MUKUPW Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.