The URL can be used to link to this page

Home My WebLink AboutPermit Application Bldg 4xxxxxAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ____________________ Permit Number: _____________________ Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial __________ Residential ___________ 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding _________ PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: __________________________________________________________________________________________ Property Tax ID #: _________________________________________________________________ Lot No.__________ Site Plan Name: __________________________________________________________________ Block No. _______ Project Name: ______________________________________________________________________________________ DETAILED DESCRIPTION OF WORK: _________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ New Electrical Meter __________ Second Electrical Meter_______________ (Affidavit required) CONSTRUCTION INFORMATION: Additional work to be performed under this permit – check all that apply: __Mechanical __ Gas Tank __ 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: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________ OWNER/LESSEE: CONTRACTOR: Name__________________________________________ Address: ________________________________________ City: _________________________________ State: ___ Zip Code: ______________ Fax: ____________________ Phone No.______________________________________ E- Mail:________________________________________ Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name: ________________________________________ Company: _____________________________________ Address: _______________________________________ City: ______________________________ State: ____ Zip Code: ________________ Fax: __________________ Phone No______________________________________ E-Mail_________________________________________ State or County License___________________________ If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. ϮͲϮϴͲϮϮ y ϯϭϵϰŝƌŵĂŶƐƌ͘&ŽƌƚWŝĞƌĐĞĨů͘ ϭϰϯϬͲϭϯϭͲϬϬϬϭͲϬϬϬϰ tĞƐƚ,ĂŶŐĂƌ ƵŝůĚŝŶŐϰ ŽŶƐƚƌƵĐƚĂŝƌĐƌĂĨƚŚĂŶŐĂƌǁŝƚŚĂƚƚĂĐŚĞĚŽĨĨŝĐĞ y y y y y ǆ ϯϮΨϭ͕ϰϮϱ͕ϴϰϬ͘ϬϬ ǇƚĞŵĞdƌĂŶƐƉŽƌƚĂƚŝŽŶ/ŶĐ WKŽǆϳϴϴ :ĞŶƐĞŶĞĂĐŚ &ů ϯϰϵϱϴ ĂƌƌǇDŽƌƌŝƐ ^ƚ>ƵĐŝĞ^ƚƌƵĐƚƵƌĞƐ ϰϴϴϴE͘<ŝŶŐƐ,ǁǇ͕͘ϮϮϱ &ŽƌƚWŝĞƌĐĞ &ů ϯϰϵϱϭ ϳϳϮͲϰϲϭͲϭϳϳϱ ďŝŐďŵŽƌƌŝƐΛĂŽů͘ĐŽŵ ϬϯϰϯϬϬͲͲͲͲͲͲͲ^>ϭϬϵϮϳ KĨĨŝĐĞϯϲϬϬͬ,ĂŶŐĂƌϭϭϵϮϲ