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HomeMy WebLinkAboutBuilding Permit Application Date: Fee Due: 1 Recei t# 7ermft# Planning&Development Services Building& Code Regulations Division 2300 Virginia Ave. © Fort Pierce,FL 34982 (772)462-1553 i SPECIALTY PERMIT APPLICATION ❑.Electrical ❑ Plumbing [3HVAC Fence loan� n N ❑ Shed ❑ Demolition ❑ Gas Siding "9ht of ,q WIi��,)v eftemft °S „ '�Ppnddntj&h* a �� Seepage 2 for instructions and additional paperwork required for specia lt y permits ed. 1. Location/Site Address: Y R Kr Ce FL, 2. Parcel IDNumber: 3S,5Z 563 I Township Range Map Page Zoning Land Use Initials Office Use Section Only 3. C//omplete Des rip ion of Project or Work: /L,•5 1p tiv ` eq 4. Owners Into m lion �O�—g 5. Contractors Information �,J Name: 6"h,Vt.,e ht �G,' FL Reg/Cert#: C�e-6ri 6 3 Address: /q 6 L �6 Y• County Cert#: City: ra' j���( State: Business Name: UC 4-'6K'j C- Zip: 'J�{ g L Phone: �' hone 354,86.j Fax: ? i 6. Value of Constructione 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 regularin ction and zoning. PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR 7 STATE OF FLORIDA,COUNTY OF SV L h(_ Ad ACKNOWLEDGED BEFORE METIES I DAYOF':TQh,4/ 4-0 20,5J BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCE i AS IDEN7AFIC TIO I ti►�YP4 ?r' KIRK ARI`KATZ MVbdbMMISSI04#FF044924 S GNATURE OF N TARY 'TYPE OR PRINT NAME OF NOTARY /�, gory pd:•` EXPIRES"August 12,2017 COMMISSION NUMBER/ © l o� (407)390=0i53 FtoridallotaryServico,com NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 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$7500.00 i Revised 04/26/2010 i i I . i