HomeMy WebLinkAboutSpecialty Permit ApplicationFee Due:
2 ermit #
Planning & Development Services
Building & ,Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC Fence
❑ Shed* ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: C1C�11 Cam' 1 1
2. Parcel M Number:
3. Complete Description of Project qr Work:
4. Owners fn or Arc
Name: Q %Z
Address
City:
Zip:
6. Value of Construction: $
5. Contractors Information
FL Reg/Cert #:
'�IOmG'tf i County Cert#:
State: �1 Business Name:
Phone: W--� 4 /6—,�none: Fax:
OWNEWS AFFIDAVIT: I certify that all of the information contained in this applicat' is correct and that all work will be done in
/ compliance with all applicable laws regul 'ng constructi nd zoning.
PRINT OWNER OR CONTRACTOR NAME SIGMA OF CONTRACTOR
STATE OF FLORIDA, COUNTY O�.}Trr��•�
ACKNOWLEDGED BEFORE ME THIS OD DAY OF _ Y 20. BY 1J ((����
1-1
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
AS NTIFICATION. _ NAN
NA INGRAM
PI00MMISSION 11 EE 050558
Bo IXpiIM *cember20, 2014
SMIIIATLIRE OF NOTARY cc TYPE OR PRINT NAME OF N ARY lhra Notary Public Undenvdters
COMMISSION NUMBER CZ-O�®Sn
'BALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED TO MEET THE FLOOD ZONE
ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on
reverse side of this sheet)
Revised 04/17/2014
NOTICE TO OWNER: FAILURE--"_ RECORD A NOTICE OF COMMENCEMENT 1; _%` 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 $7,500.00
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
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
6. Value of Construction
Indicate the street address or general location of
property where the building activity is taking place.
Indicate the tax identification number of the
property where the building activity is taking place.
Fully describes 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.
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 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 of fence height of fence and type of fence
❑ Siding Attach 2 copies of manufactures specifications
❑ HVAC.._.:._..' . -N6,attachments necessary
This;application`can`be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort.Pierce,
FL 34982'.'.All perrnit`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,.pleas_e call (772)
462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
Upon issuance of this permit, required inspections can be scheduled by calling 1-866-284-1280 or logging on to
http://codeinspectionpublic.stlucieco.gov/