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I I I I i�! E NO f 'M I aM
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a 1. �.
L�� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMITAPPLICATfON FOR:
4&t-
PROPOSED
,,,,IMPROVEMENT LOCATION:
Address: 'Z)
Property Tax I D #: 4 �o 2.
Site Plan Nameku=�t� I
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter 1 (Affidavit required)
CONSTRUCTION INFORMATION:
R
Lot No._
Block No.
Additional work to be performed under this permit — check all that apply:
JMechanical _ 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 $tLI!m sJCJ . Utilities: `Sewer _Septic
OWNER/LESSEE: CONTRACTOR:
Name Nam
Addr Ci
n
City. State. As•Zip Code: Fax � C
Phone No E:- Zip Code:
f Mai U Phone Na '%
Fill in flee le Title Holder on nex age (if different E-Mai
from the Owner listed above) State or County Licenst
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.
Building Height:
Fax
State: R L
4..