HomeMy WebLinkAboutBuilding permit app pg 1Date:~ [z,.,z__. Permit Number: ______ _
All=_; INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Planning and Dew,lopment 5enliCes
Building and Code Regulation Ditlision Commercial ___ _
Building Permit Application Residential_✓ ___ _
2300 V-,rginia A11e11ue, Fort Pierce Fl. 34982
Phone: {n2) 462-1553 Fax: {n2) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR:
Address: ~10 I So.-trn
Property Tax ID#: _____________________ _ lotNo., ___ _
Site Plan Name: _____________________ _ BlockNo. __
Project Name: ____________________________ _
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New Electrical Meter ____ Second Electrical Meter _____ (Affidavit required)
f CONStRUCT1()N ~l1C>N; .
Additpnal work to b.: pe, ro, med under this permit -check aU that apply:
~Mechanical A/C. _GasTank _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: $ ~ 1 {%(). UV Utilities: _ Sewer _Septic Building Height: __ _
Address: t Company:..D'U#JLitli.l.L..!P,..JBil~~~~:...• _
City: ti){/, Plltf_L State:~ Address:.12(!C!_f!C:.l:IA,(~l1'L....J:::l!.f4:!1,L.!~•'.___
ZipCode: ,3ljq5f Fax:______ citv:f-Ol1::Pj'Uu State:
Phone No .. -c---,-----------E-Zip Code: .3tffi I Fax:_'--------
Mail: '.2::51,. {Q53 '& Phone No71,--4<,1-414-\
Flff in fee simple Tide Holder on next page (if different E-Mail Y,0\/W½fAAt@e C6tt'
fromtheOWnerlistedabove) Stateoreoultylicense C.All!{l\lX ft
If value of construction Is 2500 or more, a RECIORDED Nallc:e of~ ls required.
If value of IIAVC Is $7,500 or-, a R£COROED Notice of C-,en-ls required.