HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: ee Due: Recei t# `'ermit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
idElectrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions�and a�,dddi�tional paperwork required for specialty permits
1. Location/Site Address: 3-5 �7 1 `v ► 11 P
2. Parcel ID Number: Z� - zzo - 0(]b\ - OC 33 -
Township Range Map Page Zoning Land a Initials
Office Use Section
Only
3.
4. Owners Information 5. Contractors Information Name: nSk�Q� - FL Reg/Cert #: 0,4I�!)ob1to43
Address: 39 o(D �Q 1(Y m bow ery i I V l T1yd, CountyCert#: 2 V z
City: �r�t�('�� State: `� Business Name:
{�rir��41 ryr L
Zip:
25Z31_�t.9
Phone.��hone:"Wi 9� Faze-`tl.p ( - ` kAS
n
G. Value of Construction: $ /I` }nZr)
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 OWNER C NTRACTOR NAME SIGNA OF OWNER OR CON A TOR
STATE OF FLORIDA, COUNTY OF-.f��' I'
ACKNOWLED I V DAY OF 20ABYI�&m� ( �r i
WHO ERSONALLY KN OR WHO HAS PRODUCED _
AS IDENTIFICATION. r% A n
S149WAT4RE 07 T E Ck P NAMEOF No{ 1 �: ANGELA M. HUFF
, MY CO, SION # EE 083530
COMMISSION NU ER .... .' EYIN S: April 12, 2015
U. Bonded Thru Notary Public Underwriters
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY REST. 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 04/26/2010