HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONPermit # - J
.St. Lucie County_.Building, & Zoning
2300,Virginia Avenue Ft: Pierce, FL 34982-5652
' 'Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical. ❑ Plumbing
❑ Shed 0 Demolition
❑-HVAC, 6,,Fence
❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site,Address:�,?"3.OF s /c!ad,4yc FBfF -PleeC- FI ,• -3(r41(7,1("e
2. Parcel -ID Number: 1-1133 7d J• 0/06, 0,
Oitice Use
Section
Townslii `,
Ran e
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. Land Use 'Initials'
Only
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% ;�2�Zoning
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3. Description of Project or Work,Aetivity:, b WOO kc
4. Owners Information
Name: 13
Address: <3 08' �6)$N d i01- /�lI/P
City: b sc P_ State:
Zip:. Phone:
6. Valu.e:of Construction: $ / .f70 .
5. Contractors Information
;FL Reg/Cert #: 060A167� -
County Cert#:
Business Name:
Phone Fax
OWNER'S AFFIDAVIT: I certify that' al of the information contained in this application( is correct and that all work will lie done
in compliance with all applicable laws regulating construction and zoning.
A 1 f-►27' u.lueA 0,41"
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS "`t DAY OF
20� BBY r0/MV_&1-6k1/154!n WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
(seal)
SIGNAVAE OF NOTARY TYPE OR PRINT NAM F NOTARY
TITLE: NOTARY PUBLIC
COMMISSION NUMBER
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
AUDREYB.HUMPHREY
MY COMMISSION k DD 190387
EXPIRES: March 6 2067
P °•`' Bonded Thru Notary public Underwriters
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE .bF COMMENCEMENT MAY REsu"%r IN YOUR PAYING,1NICE 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 iriformation.in the%space provided. All information:mustbe printed (use black or blue ink
only) or typed. This permit application isito 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 addressor general location of the
property where the building activity is taking place. .
2. Parcel ID Number Indicate the tax identification number of the property
w}iere the b" i}din ' activi g ty is taking:place:
3. Description of Project or Work Activity
4. Owner Information
f
i
5. Contractor Information
Fully describe 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.
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
j. costs associated with the building/construction activity.
Construction value is used to determineAhe 'perrnit 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 construdtion.-
El
,.
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 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