HomeMy WebLinkAboutSpecialty Permit Application02/26/2007 14:33 7 ELITE ELErTD.TC INC PAGE 02
6 I
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St. Lucie County Building & Zoning
M 2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
Electrical Plumbing ❑ HVAC ❑ Fence
Shed R Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: _ 116
2. Parcel ID Number: l k 1- 13q- 600.E -6 ► 6' -�_
Office Use
Section
Townshi
e
I Mgip Page
I Zoning
Land Use
In' ' Is
Only
3. Description of Project or Work Activity: 6� i / — 1 % Vol,-Qq 6 t 0 U6XNQ'l D
n rl I(! G. Tn � � (�fU • . � if1 �� C
4. Owners Information
Name: WCi (`1w Si. UtGf, LL-
Address: `r LLOtuY�h F /7�I W
City: State:�
Zip: Phone: Q
6. Value of Construction: S 0 /
5. Contractors Information
FL Reg/Cert #: F Roo
County Cert#: 13
Business
Name:
Phone oJl%' Fax 3 q0 _3 1%6o�
OWNER-S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done
in compliance with all applicable laws regulating construction and zoning.
.1oH �qAlxxwz
PRINT QUALIFIERS/OWNERS NAME( -ram % p�- SIGN EOFQUA III /OWNER�1, Y47
STATE OF FLORIDA. COUNTY OF 3I . Ut V L, AC I BFFORE ME THIS .,v O `DAY OF
r , 200, BY aDH-tL) PgNK2 3 Z FtO IS PERSONALLY KNOWN TO ME WHO HAS PRODUCED
---f� AS IDENTIFICATION.
—iU�Ncu LEC LFIN(��1.� tscan
SIG TURF OF NOTARY TYPE OR ITWNT NAME OF NOTARY
TITLE: NOTARYPUBLIC
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
COMMISSION NUMBER I)pik
NANCY LEE LANGFORD
(z MY COMMISSION# DD362231
E%PIBES: October 12, 2008
E
RY FL NY,<ry OluouM Avaa. Co.