HomeMy WebLinkAboutBuilding permit app pg 1All ~IN~ MUSr BE COMPLETED FOR APPLICATION TO BE ACO:PIID
Date: _Jj.31 l.J-,__, Permit Number: _____ _
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Building Permit Application
Planning and Deve/opmf!nt Services
Building and Code Regulation DMsion Commercial ___ _
2300 Virginia Avenue, Fort Pierre FL 34982
Phone: (772) 462-1553 Fax: 1772) 462-1578 CBDG Funding ___ _
PERMIT APPLICATION FOR: A c,. Chhl -Ol)i:-
LotNo .. __ _
Site Plan Name: _____________________ _ Block No. __ _
Project Name: ____________________________ _
New Electrical Meter ___ Second Electrical Meter _____ (Affidavit required)
I CONSlRUCOONtNFORMA1lOf4:
Additjonal work to be perfonned under this permit -check all that apply:
~Mechanical ft/C. _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
Electric _Plumbing _ Sprinklers Generator Roof Pitch ---
Total Sq. Ft of Construction: ______ _
Cost of Construction:$ 51-0 0. 0 0
Sq. Ft. of First Floor: ________ _
Uti&ties: -Sewer _Septic Buikfmg Height __ _
Name,---4.14l..41,,i.,,_~u..ut;..4-U-------Name: J!lii'.;' ~~~~~~~..--.,,---
Address: 14-'-J r.,3 Co,ncu-11 Ml: Company:.:l2JIU/IJ.___c_41-~,..ru1,!!J;!~~--
City: fv(b Pjtra State: Ff.,, Address: ~~O-,l..la!IL4!!Jf6,__c;au.:~=-· -
ZipCode: 3,ttl51 Fax:_______ city:00::PIUu State:
Phone No. z.z_q.g,gt §J/:2-{, E-Zip Code: ,3u't)I Fax: _____ _
Mail: Phone No11:)--4<.1-41~ I
Fill in fee simple Title Holder on next pace (If different E-Mail loo\/11.~l.\.fih@-MY'
fromtheOwnerlistedabove) StateorCouitylicense c.Ac:1.ua1x f,
If value of construdion is 2500 or more, a RECOROED Notice af Commencement is required..
If value of HAVC Is $7,500 or-. a RECORD£D Natke of Co11•-•-is required.