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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1*02
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Date: ' Permit Number: 2
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�--` Building Permit Application
Planning and Development Services ,
Building and Code Regulation Division Commercial Residential VVV
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
s
New Electrical Meter Second Electrical Meter
Lot No._
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical — Cyas 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: $ 4b6Utilities: —Sewer _Septic Building Height:
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�"eYfL'c"'., Cg-r`s Hz4 �1' .:,u,�,°'., $�iekt,' n ..„+a. x ..�'k-,.r- �:�i`s','" . ✓.,
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Name
Name:
Address:
Company:
City: State: _
Zip Code: Fax:
Phone No. — —��(,
Address:
City: 1' 1
Zip Code:
Phone No ` -1 r
State:•
Fax: —
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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State or County License- ,:LH
_,I[It value of construction is Z5UU or more, a RECORDED Notice of Commencement is required.
-Ff value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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