HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONFee Due:`-
r �
_ " Permit #
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561462-1553
OR10P'
SPECIALTY PERMIT APPLICATION
W Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
3g990
2. Parcel ID Number: In - 0010�/ R
Office Use
Only
Section
I ownship
I Range
I Kap Page
I Zoning-
- Land Use
Initials
a
140
S
W U
3. Description of Projector Work Activity: ��) ['— I .z,,,, un d . sr � r n n A a �� A r; L .
4. Owners Information
Name: ) ; i rxn �. 14 a
Address:
City: �a State: T ( -
5. Contractors Information
FL Reg/Cert #: C_ rC)( Q S a 3 S 8
lCounty Cert#• 4-,m ti c9f757f7
Business Name: on s� ; �, -1„ C
Zip: 3u q90 Phone: SIC, BSI (Tor- 1 Phone Fax -7-7z -�a � c)(o 84.
6. Value of Construction: $ ��J o
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and al work wbe c
n compliance with all applicable laws regulating constru5ti an oning.
PRINT QUALIFIERS/OWNERS NAME SI ATURE OF QUALIFIEWOWNER
STATE OF FLORIDA, COUNTY OF / I RA AJ ACKNOWLEDGED BEFORE ME THIS 2— DAY OF
-y C` 20� BY /( H A 4 N al - dq- WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
r
TITLE: NOTARY PUBLIC
St. Lucie County Specialty Permit Application rev. 8/25/05 ding
MY NWEt5tMIidt>'
EXPIRES October 08.
PATRICIA JONES
4' MY COMMISSION 4 DD723038
EXPIRES October 08, 201:1
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, Fl- 34982
Phone: (772) 462-1553 Fax: (772)
462-2522
Fees/Payments
I
i
-
1
APPLICATION•- •
"
�Rermit Type Electrical'
0711-0093 Npplication Type,
the Counter Permtt _
-Other.
Issued Activity Type
Stories
�toniatic Sprinkler System?"Q , `
FEES
A•.
Pay Fee ,
Code' Type �; - Account �!;• :" "Quantity
', Amount
Date Posted Paid?'-', .Now? .,
Permi7.01
06-Permit Fee - Electrical Permit - (1
491 2415 322000 200
$75.00
11/08/2007
❑ "
BIMS651°
06-BIMS. •"
4912415322050,200 "
$5.00
11/08/2007
Yes
Permi701
06-Permit fee - Electrical,Permit - (1,
491 2415 32200Q200 ,- `
$75.0,0
11/08/2007
Yes
,
)ate Entered 11/08/2007 .- Dafe Paid 11l08/2007
''Entered gersteml Historical? No