HomeMy WebLinkAboutScan_20220218 (10).pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d `a Permit Number:
L
Building Permit Application
Planning and Development Services
j3uildin ' and Code Regulation Division
2300 Vie info Avenue, Fort Pierce FL 34982
Phone: 4 -1 Fax: ('772) 4 -157
PERMIT APPLICATION FOR;
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
C —
1
Ll
Residential
r� Lot No..
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New Flectrical Meter Second Electrical Meter lJAIIIUdVlt I CLJU11 �U J
CONSTRUCTION INFORMATION
Additional work to be performed under this permit — cheek all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Constructiond.
cost of Construction
OWN ER/LESSEE:
Gas Piping
Sprinklers
Shutters
Generator
5q. Ft. of First Floor:
Block No.
Windows/doors Paid
Roof
'SewerSeptic Building Height:
Utilities:
Name �
Address: I aLpu�
City: State. � �...
Zip [ode: ' fax:
Phone No. A';;� iat-J, E-
mail:
Fill in fee pimple Title Holder on next page cif different
from the Owner {fisted above)
CONTRACTOR:
Pitch
Name.
Company: CCXDNkM
Address:
city-., 4_,J�rc-N L YtA State.
Zip Code: �Q�I � Fax:
Phone No
E-Mail �
State or County License LL-
i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is RECORDED Notice of Commencement is required.