HomeMy WebLinkAboutSpecialty Permit ApplicationG
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical
❑ Plumbing
❑ HVAC
Fence
❑ Shed
❑ Demolition
❑ Gas
❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: i� o-�, S •Y�c�tGi (l�l>~ e- �.-�• �(eCC2 il- 3 y�Sa
2.�Parcel'ID Nalrrber: �Sl� � � �%� - � CjC� l - Cj �j•D � 3.
O,'ffice Use
Only
Section
Townshi ,.
Ran e_
Ma Pa a
2�oning
Lanq Use
InEKE
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3. Description of Projector WorkAetivity: - ; V
4. Owners Information
Name:
Address: ✓.�,C�cQ1Q�\��( �C
City:. State: a \�
5. Contractors Information
FL Reg/Cert #:
County Cert#: 5 q ✓ V
Business Name: A, Gux'k_ vxc.Q.
Zip:. ?jya � a— Phone: -772 -596- lgs 'hone77,? 8/� -Oa,1,3 Fax 771 ' �0% .17a .
6. Value.of Construction: $
OWNER'S AFFIDAVIT: I certify that"all of the information contained in this application is correc and that all work will be done
in compliance with all applicable laws regulating constructio and zo
h
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
Q
STATE OF FLORIDA, COUNTY OF S .il f G(1 L%. e. ACKNOWLEDGED BEFORE ME THIS DAY OF
20r4 -7 BY - . ( HOT ERSONALLY KNOWN TO OR WHO HAS PRODUCED
AS IDENTIFICA N.
D 1
'Z-- ��0, ic M ' !`�' C �'� • (seal)
SIGNATURE OF NOTARY TYP OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER X, "I
St. Lucie County Specialty Permit Application rev. 8/25/05 ding zmvlti M RAC1N9
=•; `: MY COMMISSION # DD668160
E EXPIRES April 26, 2011
en�f 9�n_n�R9 FInrWANNANSANiEs.COrtl
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 $5,000.
INSTRUCTIONS
Please complete all information.in the space 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 Indicate the street address or general location of the
property where the building activity is taking place.
2. Parcel ID. Number • Indicate the tax identification number of the property
where the'buildirig activity is taking place.
3. Description of ProjecI or Work Activity Fully describe the activity to take place.
4. Owner Information Indicate the name and address of the owner of the property
on which activity'is taking place.
5. Contractor Information 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 rigl5t 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 schema,tics with tank size, location, and BTU of each. appliance
❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans; 2 anchor specifications
❑.Fence Attach 2 plot.plans showing location offence height of fence and type 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 Building and Zoning, 2300 Virginia Avenue, Fort
Pierce, FL 34982. All per 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