HomeMy WebLinkAboutSpecialty Permit ApplicationApr 29 2000 01:13AM HP FaxN"� -`lb Sales 7728710863 pa. —
Date: Fee Due: p Recei t# t1I Permitit /I
Planning & Development Services
Building & Code Regulations Division y
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462.1553 471 N
SPECIALTY PERMIT APPLICATION kU) G
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❑ Electrical EJ Plumbing ❑ HVAC ❑ Fence 1
❑ Sued ❑ Demolition ❑ Gas ❑ Siding A?Wn
Seepage 2�fo?r inst�r wfio[n's�and additional paperwork requiredforspecialty permirs
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1. Location/Site Address: 2[c7 1 , US �, ��y-+S* Ju c-� e 3gcl�
2. Parcel ID Number: 14 Q C�- 40c) -0 ti
3.
(1ffIce Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
ITS
to De�sycription of Project or Wark: . l- i f1
4. 0%,ners Information 5. Contractors Information
Name: M rkne)
Address: En 1'Ac-IniyEh C�
City: I opern e. Stater
Zip - e G is Phone..
6. Value of Construction: $ V ()- ()10
FL Reg/Cert #: C"F= C I
County Cert#: 1431 q
Business Name: 1% nanl� a �LJ eS. -(erl 1 C,4.-
Phone ( r�� Z Fax• — Q g &3
OWNER'S AFFIDAVIT: I certify that all of the information contLin a p ' tion is corr and that all work will be done in
compliance with all applicable laws regeti nd zoning.
V)qPRINT OWNER OR CONTRACTOR NAME F OWNER OR CONTRACTOR
STATE OF FLORMA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY 0 20 I
WHO IS PERSONALLY KNOWN TOME V OR WHO
PRODUCED
AS ID IFICATIO
T �as,r� • Lori Diodato
�+'' - ( U I df Q� ff.; �'Of
COM�ItSS�fEE856794
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY %;0W jf{lt�, FEB. 09, 2017
yhaefl�.a WWW-AWNNOTARL�
COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IIX 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
Revised 94/262010
Apr 29 2000 01:13AM HP FaxM! i Sales 7728710863 pa(J-
Mieranda sales & Service, Inc.
75o NW Enterprise Dr. ST'Exoo
Fort St. Lucie, FL 34986
To: rz From
Company:
Fax: -"n Date: C\
# of pages (Including cover)
FYI P1s call when you receive URGENT
Comments:
if you have any questions, or do not receive all of this fax,
please call 772-878-5123. ^- Thank you.
Have a great dayll