HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION-� Date: Fee
Zoning
I Permit # /17UY ' UUa
17
Office Use I YCtio
Planning & Development Services
BY Building & Code Regulations Division
1"12300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 fur insfruefions and additional paperwork required fur specia&y pernzks �+
1. Location/Site Address: _;� }j 0 L5 k u Y, Dr. P4-. 3 q % s/
2. Property Tax Identification Number: 1 3 1 5 `
3. Complete Description of Projector Work: ��,��� d��%�Q O&/sI-Z
4. Property Owner Information Contractor Information
Name: �'�; ' ?/l," ����� FI Reg/Cert #: e�Ga'OO®�/ :� County Cert #:
Address: Business Name: lV('jy��
City: State: Email:
Zap: Phone: Phone. 7, r Z•?07-5-7,2r Fax:
OWNER'S AFFIDAVIT: I certifS- 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 consUactan and zo
I
PRINT OWNER OR CONTRACTOR NAME SIGNATL F O R C R
STATE OF FLORIDA, COUNTY OF��
AckNowLEDGED BEFORE ME THIS DAY OF 20 I D . BY 15I " IQ 0
WHO IS PERSONALLY MOWN TO ME OR WHO HAS PRODUCED a , ) & • p1��
AS PAVNTIFICATION. n �o• �', •��' C
l� (sral) `f
SIGNATURE OF T Y TYPE OR P AME OF NOTAR
COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEhIENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEbIENT.
EXEMPT: A/C HEAT REPLACEAIENT WITH CONTRACT UNDER $5,000.
I
SLCPDS re%rised 04/26/2010
�' ,=oti�""'yam•,, AUDREY B. HUM;';iREY
MY COMMISSION # DD 633047
EXPIRES: March , ....oe,. 201i
Bonded Thru Notary Public Undon: iter;
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use blue or black
ink only) or may be typed. This permit application is to be used only for those activities that are not
other wise included under a primary building permit. This application may not be used for any activity
that includes structural alteration. The information provide with this application includes:
L Location/Site Address Indicate the street address or general location of the property
Z. Parcel ID Number
iI
3. Description of Project or Work
4. Owner Information
S. Contractor Information
6. Value of Construction
where the building activity is taking place.
Indicate the tax identification number of the property where the
building activity is taking place.
Describe in detail the activity to take place.
Indicate the name, address, & phone number of the owner of the
property on which the activity is taking place.
Indicate the State of Florida registration number (if applicable),
the 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.
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 the submitted figures
are not consistent with similar types of construction.
Gas 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, and 2 anchor specifications.
Fence Attach 2 plot plans showing location of fence height and type of fence.
Siding Attach 2 copies of manufacturer's specifications.
13VA/C Attach 2 residential energy studies, 2 Manuel J calculations, 2 sets of duct lay out (for
new system or full replacement).
This application can be submitted to St. Lucie County Planning & Development Services Permitting
Department located at 2300 Virginia Ave, Fort Pierce FL 34982. All permit applications must be
filled out completely. 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:
Monday through Friday, 8:OOa.m. - 5:00 p.m.
Note: Emergency electric service change out inspections will be not be performed after 3:00 p.m.
without special arrangements and additional fees paid.
Upon issuance of this permit, required inspections can be submitted by calling (772) 462-1261.
SLCPDS revised 0426/2olo.