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All APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TO8EACCEPTED
Date: ��i ��\� Permit Number:
Building
Permit Application
�i ���Un�U�� " ����n� ^���nU���on
Planning and Development Services
Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL34982
Phone: (772)462'1SS3 Fax: (772)46J'lS78 COD0D1erCi8lReSid9Dti3l___________
|PERMIT TYPE: 0 |
Address:
Property Tax /D #: q 5 -4-0 \ Lot No`________
Site Plan Name:
Project Name:
Additional work to be performed under this permit -check all that apply:
Block No.
—Mechanical GasTank Gas Piping __Shutters VVindows/Doors
Electric _L~P|umbing Sprinklers __Generator Roof Phzh
Total Sq. Ft of Construction:
Cost of[onstmct\� Construction: s
Sq. Ft. of First Floor:
Utilities: __Sewer __Septic Building Height:
`
[by: State: 1 �7/
Zip Code: Fax
Phone No.
E'MoU:
Fill }nfee simple Title Holder onnext page (|fdifferent
from the Owner listed above)
Company:
u_,�-
Z]p[ode: ,)- Fax
Phone No \
E-Mail
State or County License C_ 'I'- C_ � 14 7- C i
if value of construction is $25O0urmore, aRECORDED Notice ufCommencement isrequired.