HomeMy WebLinkAboutSpecilaty Permit ApplicationDate: Fee Due: �(17)0 I Receipt# Permit # ()gm..! da0 I
5t. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical.
Ef Plumbing
❑ HVAC
❑ Fence
❑ Shed .
❑ Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: ' G 0/ L/ su,►, .s r r 'Ovo
2. Parcel ID Number: 3 y Dd ' - 6 O 9 - 0 6 % / - OC70 - a
Office Use
Only
Section
Townshi
Range
Map Page
Zoning
Land Use
In' 'als
/ /
I 36 S
'106
3-11 JIS
RS- K
SF Rcs
3. Description of Project or Work Activity: 14coK w.° Gtry wn rE/Z To-/-/oµs-e .
4. Owners Information kanhu-
Name: /VArJC Y 1740fe6d
Address: ( p / Y S,4 ,► 5E r f61. v a
5. Contractors Information
FL Reg/Cert #: CFe OS 6G YY
County Cert#: l ` 99
City:
Faar PiCRce
State:
ri-
Business Name:
Awr
Srovc e '
PGy-ya�Nc
Zip:
.3 y 9*d
Phone:
doy -d5 71
Phone 97fr- 69a 9
Fax
8�79--
d 7 / 7
6. Value of Construction: $ .350.
o0
OWNER'S AITIDAVIT: I certify that all of the information contained in this app
in compliance with all applicable laws regulating construct
E
ARr .5royE.e
PRINT QUALIFIERS/OWNERS NAME
and that all work will be done
SIGNATURE OF QUALiFIER/OWNER
STATE OF FLORIDA, COUNTY EG
Y OF ACKNOWLDED BEFOREE'I M'IIIS f L( DAY OF
/' , 20 0(Q, BY /'lI&M(At S �01PiL WHO IS PERSONALLY KNOWN TO ME OR WI-10 HAS PRODUCED
SIGNATURF `/
TITLE: NOTARY PUBLIC
AS IDENTIFICATION.
(Seal)
IT1113 Olt PRINTNAME OF NOTARY
COMMISSION NUMBER
oov k Notary Public State of Florida
? Dianna Peloquin
�I My Commission DD829917
'�ofPdO Expires10/09/2012
St. Lucie County Specialty Permit Application rev. 8/25/05 ding