HomeMy WebLinkAboutSpecialty Permit ApplicationDate: Fee Due: %'0.y L)" I Receipt# Permit # 0 b0 ] - U I &
St. Lucie County Building & Zoning 6;P a c 8'0 �(--0 3V (D
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
+ Tel. •462-1553
SPECIALTY PERMIT APPLICATION
E�Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: O )- 7 5- S 6uf # /
2. Parcel ID Number:
Office Use
Secfio�nTownship
Range
Map Page
Zoning
Land Use
Initials
Only
3. Description of Project or Fork Activity: Z_ C(, /rt,
4. Owners Information /MQLNTL(1�05. Contractors Information
Name: FL RRe�eg/Cert #: C Q�j �0 1� z
Address: �30rn0JIAS�(bfintyCert#:
City: State: gal Business Name: /( C 1 f/a-- V/ /i rr��
Zip: r tj`'(p�✓ Phone: Phone Y,,G- L[ Fax
6. Value of Construction: $ 5-0 0. 0
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 regulating construction and zoning.
PRINT QUALIFIERS/OWNERS NAME
STATE OF FLORIDA, COUNTY OF
200SBY iw
R
SIGNATURE NOTARY
TITLE: NOTARY PUBLIC
0
SIGNATURE OF QUALIFIERIOWNER
ACKNOWLEDG�IS L3 DAY OF
IS PERSM—ALLY
AS IDENTIFICATION.
TYPE OR PRINT NAME OF NOT
COMMISSION NUMBER
OR WHO HAS PRODUCED
NW E SAIBI —
My U NINSM N DD iWe
EXPIRES: J3dy 29, 3010
3mdad Tier Now Pw* und& w nw
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
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
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 the
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 activityis 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.,
❑ Gras 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 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 permit applications must be filled out completely before submission. No applications
will-.be,accepted-;f6r=pr6.cessing after 4:30 P.M. For assistance in completing this application, please call
(772) 462 �l'S I,',. ring•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