HomeMy WebLinkAboutSpecialty Permit ApplicationSPECIALTY PERMIT APPLICATION
• Elect'rical
0 Plu m*' bing;
011VAC,
0. Fence,
• Shed
Demplition
❑ Gas
❑ Siding
See page 2for instructions and additional paperwork,requiredfor specialty permits
1. Location/Site, Address:. 4. V? A VR14 Li e___
2. Parcel -ID r um- er:
6irice" Use' "I
Only
Se4i6n
'Map Page
I Zoning
Land Use �j
, is",
Initials
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15E
F (:;7
JG4 OLP
1 -P_S41
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3. Description;of Project or-;VVorkActivity. ,
4,. Own e_rs-Inform Mi6h,
Name:'
Ad tes'si, "Wo Ch0M'r30qyr CTVl/
City: N/qeV-O State:'.
Zip:.' _.,Phone:.
& Valup,ofCopsttuction: $
WIM,
5. Contractors Information
FL Reg/Cert #: 2-
County Cert#: C9 30
Business Name: M Lnsco - -DIC
Phon�S2)6(6.9-635Fax (3529579-S4
0 E'Ril"S FIDAVIT�:' "' ]C*d*tt��yih�i'�511di�'�he--inf6'rmation"co'iii'ainedin and that all work A'118e done-'
WN Hcation'isco
in compliance with all applicable laws regulating construction and zoning.
MCAY-A LA v -S 6e-
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS DAY OF
404"664y ktxg-4-VA12 _:7beXW7j�,ONALtY KNOWN TO MEORWH(j HAS PRODUCED
43_e� - SIio ..'s �3
AS IDENTIFICATION.
eatriz SMano
{seal)
SIGNATUREMY OPNOTAgy TYPE OR PRINT NAME D228304
11, 41)
Expires: Jul 01, 2001
TITLE: NOTARY PUBLIC COMMISSION NUMBER Bonded Thnj
Atlantic BondingCo., Inc.'
I
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE .OF COMMENCEMENT MAY tcJLT, IN `YOUR PAYING TWICE. ,FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT:'A/C-HEAT. REPLACEMENT WITH CONTRACT -UNDER $5,000.
INSTRUCTIONS
Please complete all information.in thespace provided. All information_must.be printed (use black or blue ink
only) or typed. This permit application is to be used only for those activities that are not otherwise included
under a primary building permit.;This application may not be used for any activity that includes structural
alteration. The information to be -provided with this application includes
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
Indicate the street address or general location ofthe'
property where the building activity is taking place.
Indicate the tax identification number of the property
where.the'building activity -is taking place:
Fully describe the activity to take,place.
Indicate the name and,address-of the owner of the property.
-on which activity is taking: place.-
Indicate the State of Florida registration number (if
applicable), St Lucie County. contractor license number .
and the name of the business doing the work.
6. Value of Construction Indicate the total value of the work to take place. Total cost
of construction includes all current retail material and labor
costs associated with the building/construction activity.
Construction value is -used to determine the permit fee. St.
Lucie County reserves -the right -to question and/or modify
the indicated value of construction if it is demonstrated that
the submitted figures are not consistent with similar types
of construction. .
Gas Attach 2 -piping-schematics with tank size, location, and. BT.0 of each appliance
❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans; 2 anchor specifications
;Fe11Ce . Attach 2'01ot plans stowing location of.fence.height of fence andtype offence.
❑ Siding Attach 2 copies of.manufactures specifications
❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement -
This application can be submitted to St. Lucie County Buildin ' andZoning, 2300 Virginia Avenue, Fort
Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications
will be accepted for processing -after 4:30 P.M. For assistance in completing this application, please call
(772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
NOTE: Emergency electric service change out inspections will not be performed after 3: 00 PM without
special arrangements and additional. fee paid.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg