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BUILDING PERMIT APPLICATION FINAL
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 'J Lio Ll'rCE2 Building Permit Application Planning and Developm cn t Services / Building and Code Regulation Division Commercial Residential !� 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1518 CBDG Funding PERMIT APPLICATION FOR: 4N&,� r- fla(' — N�r(Yil0 Address: I W 14 LIV G is i< of ` - Property Tax ID It:1 �o © ILD0 r Lot No. Site Plan Name: Block No. Project Name: New Electrical Meter Second Electrical Meter (Affidavit required) AN Additional workto be performed under this permit- check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors Pond_ �i _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: S F!' ' So. Ft. of First Floor: Cost of Construction:Utilities: _Sewer Septic Building Height: Name r Name: Address: Address: S'9�i P r7r4%Vt w: Company: city: A--OYk ? L iXC_.f-- State: i[l— Zip Code: 3 L% Fax: Phone No. '.7 u va ji_ E- Address: City: State: Zip Code: Fax: Phone No Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License IT value or construction IS L]UU OF more, 3 KILLUKtitti Notice of L mmencement a reguirea. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.