HomeMy WebLinkAbout1307-0126 SPECIALTY PERMIT APPLICATIONFee Due:
COUNTY`
F L O R I D A
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing
❑ Shed ❑ Demolition
❑'fIVAC ❑ Fence
❑ Gas ❑ Siding
Seepage 2 for instruchans and additional paperwork required for specialty permits
1. Location/Site Address:
I2�54oz LJQ e4+Le,0 Cu" ',jutFoc'� &A4 �0 3W$I
2. Parcel ID Number: 1312 -sGD -O II I - 600 - 7
Uflice Use
Section
Township
Range
Map Page
Zoning
Land Use
Initials
Only
3. Complete Description of Project or Work:
4. Owners Information 2 5. Contractors Information
Name: '6cuce� GC6 IJ/YIQy� (1
Address: _Sqb a ,Q(/ILo CAIIJL UlUL
City: R-'(� Lp State: �-L
Zip: 3"6I Phone: (712)'41-OW3
6. Value of Construction: S �27`J- 00
FLReg/Cert#: ( 6cos-1 LYttiT
County Cert#:
Business Name: / lAfXtJ AAP.
(llw Lt-k.d*!n
Phone: 'f S4w, 5 +il/S
OWNER'S AFFIDAvrr: I certify that all of the information contained in this application is correct and that all work will be done in
c compliance with all applicable laws regulating construct andArn��
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PRINT OWNER OR CONTRACTOR NAME ''SI ATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF FW- Tari e
ACKNOWLEDGED BEFORE ME THIS 9th DAYOF 31ily ,201'1 .BY $amlle1 T- Durblm
WHO IS PERSONALLY KNOWN TO ME _ OR WHO HAS PRODUCED .avvx�:NKE Et �Ai
AS IDENTIFICATION. �\ : 6,0MISS/0.4-,
�. �� Arne E. Cabral
Si ATURE O OTAR TYPE OR PRINT NAME OF NOTARY s ' •
y : CD S4B14g
COMbIISSION NI7MEER t)� 9S'ap 6� �+, 9,�•
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOiNP6j�+ (SPj}
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, C
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
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YOUR