HomeMy WebLinkAboutReceipt_2022-01-19_214035.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:�e
Property Tax ID #: 3� --ow-0 —coo— Lot No. 9
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
C
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ l�o Utilities: —Sewer —Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
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Name:
Address: A 0 ZA es QZ—
Company:
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City: l"OrC4 Sf UAU e State: _FE-
Zip Code: 3'(O/S�_ Fax:
Phone No. E-
Address: Z 9
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City: POi�i�Wuf
Zip Code:
Phone No 77
Fax:
--777-00f
State: Fl-
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Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ! (t4C C 4.q
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State or County License C RS-
9 08
u value or construction is z�uu or more, a KtcuKutu Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.