HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONI "7q.10
bate:I Fee,Due• ; �� ;Receipt# �• ( 'Permit # V
St. Lucie County'Building & Zoning
2300.Virginia Avenue Ft. Pierce, FL 34982-5652
*XANNED Tel. 561-462-1553
i Y
. � ,j8C(D §PECIALTY PERMIT APPLICATION
39E}ectrical Plumbing
❑ I ❑ HVAC . Fence
Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
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cation/Site Address:
ID Number: �%' 7 -�� °" �� � J _'• ��� T ."d �� ,� . ..:...
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Office Use
Section 1.
Townshi�, I
Ran a
"Ma Page
I Zoning
Land Use *1
Initials
Only
of Project or Work -Activity:
4. ners Information 5. Contractors Information
Na e: C�/l�e4e,5 � ei1 Ytt'1 FL Reg/Cert
Adl ess: 14's , ind«.n %i vef-,b2, C®unty Cert#:
City erce State: 1. Business Name: Hook), Un
Zip 900 Phone: Phone �370Fax tit? 7 . Ll
6. E, alue of Construction: $
is 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 QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIERIOWNER
TCOUNTY
ATE OF FLORIDA, OF ��// ACKNOWLEDGED BEFORE ME THIS DAY OF
2p� BY (/ %i7�?/'I�(�/ � t Q QHL6 IS PERSONALLY KNOWN
�TOyAME OR WHO HAS PRODUCED
�
• AS IDENTIFICAT ON. 3l v - �� �� / J � , 6� + `r
SIG AT OF OTARY E OR PRINT NAME OF N ARY
TITLE: NOTARY PUBLIC
St. �ucie County Specialty Permit Application rev. 8/25/05 dmg
COMMISSION NUMBER
Y P �!3itllSmR::ll'Y'a�:XS
AUDREY 8.
=* Y MY COMMISSION # DO a !'
EXPIRES: March 6, 2r; ; i 6 l
A, ;;°•`` Bonded Thnu Notary public Unaer i r
NOTICE TO OWNER: FAILURE TU- CORD A NOTICE -OF COIv3MENtEMENT'MA' - .: SULT, IN YOUR PAYING 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.
EXEVIPT:'A/C-HEAT REPLACEMENT WITH CONTRACT UNDER $5,000.
INSTRUCTIONS
Please complete all information in the space provided. All information must. be printed (uack se blor blue ink
only) or typed. This permit application is to be used only for those activities that are not otherwise included.
under a primary building permit. This application may not be used for any..activity that includes structural
alteration. The information to be provided with.this application includes:
1. Location/Site Address Indicate the street address' or general location of the
property where the building activity is taking place.
2. Parcel ID. Number Indicate the tax identification number of the property
where the building activity is taking place.
3. Description of Projee$ or Work Activity Fully describe the .activity to take place.
4. Owner Information Indicate the name and address of the owner of the property
on which actwity is taking place.
5. Contractor Information 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 retailmaterial and labor
costs associated with the building/construction activity.
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 I that
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, 2 anchor specifications
❑. Fence Attach 2 plot plans showing location offence height of fence and type of fence
❑ Siding Attach 2 copies of manufactures specifications
• _ I
❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement .
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.PM. 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