HomeMy WebLinkAboutBuilding Permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ?) Permit Number:
LJo L�l�allL� F�h:
*VP ° 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: .0tVac . +C !�
PROPOSED IMPROVEMENT LOCATION:
Address: - l- I-v
PropertyTax ID #: C ' Lot No.00, I
Site Plan Name: //��__ Block No, T7
Project Name: Gf-1
DETAILED DESCRIPTION OF WORK:
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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: $ _ Ji Lac V _ Utilities: L!Sewer _ Septic Building Height:
OWNS /LESSEE:
CONTRACTOR:
Name 6 0
Name: r
Address: Et k
Company:r
City:bA Elea Stater
Zip Code: r]�r�• Fax:
Phone No.-7 L - E-
Address:
City: EAds c State:--
Zip Coder virl 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 L4_ 1_1
11 VdILM U1 1.VF1btrUCSIUn 6 L7uu or more, a Ktc.UKUtu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.