HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONLaic: 11 1 ree roue: Recei t# Permit'# Q( 9
y - St. Lucie -,County Building Zoning
2300- Virginia Avenue 'Ft. Pierce, FL 34982-5652
R`pP Tel. 561 462-1553
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SPECIALTY PERMIT- APPLICATION/nLLZt-�til>
❑ El ctrical ❑ PIumbing ❑ RVAC 0 Fence
ElSh - d ElDemolition ❑ Gas -❑ Siding
Seepage 2 for instructions ancfadd[tionalpaperwork required for -specialty permits
1. LocE tion/Site Address: 0 �� 3 8 (,( PS (� G 3�95-D.
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2. Para I,ID Number:
Office Use
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Section
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Land U_se
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3. Description
of Project or/ Work Activity: �14ar rVi(26a4ag Ldot
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4. Owne s-litformat' 79 5. Contractors Information
Name: vsz ASS ark L. FL Reg/Cent #:
Address• o: f
. �G h4 . County Cert#:
City: iSt,
1"'� Business Name:y .
Zip: Phone: i —� Phone 1 '
� 7 Fax
6. Value of Construction: $
OWNER'S AF} IDAVIT: I certify that all of the information i:ontained in this application is correct and that all work will be done
in compliance with all applicable laws regulating cons etion and zoning.
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF.bUALIFIE OWNER
STATE OF FLORIDA, C NTY OF �f C
ACKNOVI'LEDGED BEFORE ME THIS / DAY OF
. 20 El . BY�'
R'H01S F RSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
SIGNATURE -OF NOTARY TYPE OR PRINT NAME OF NOTARY (seal)
TITLE: NOTARY PUBLIC COMMISSION NUMBER NOTARY PUBLIC -STATE OF FLORIDA
Nicole Ferguson
Commission # DD531741
Expires: MAR. 22, 2010
Bonded 1bm Atlantic Bonding Co., Inc.
i
NOTICE OWNER: FAILURE T^. RECORD A NOTICE OF COMMENCEMENT -MAY RESULT -IN YOUR -PAYING TWICE FOR
IMPROVE JTS TOYOUR PROPERTY. IF YOU INTEND'' ^ 'BTAIN FINANCING, CONSULT WITH YOUR
LENDER Gm;,N ATTORNEY BEFORE RECORDING YOUR ICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5:000.
INSTRUCTIONS
Please c mplete all information in the space provided.. All information must be printed (use black or blue ink
only) or ed. This permit application is to be used only for those activities that are not otherwise included
under a rimary building permit. This application may not be used for any activity that -includes structural
alteratio i. The information to be provided with this application includes:
1. LocJion/Site Address
2. Parcel ID Number
3. Desc� iption of Project or Work Activity
4. Owns r Information
Indicate the street address or general location of the
property where the building activity is taking place.
Indicate the tax identification number of the property
where the building activity is taking place.
Fully describe the activity to take place.
Indicate the name and address of the owner .of the property
on which activity is taking place.
5. Con actor Information Indicate the State of Florida registration mith er (if
applicable), St. Lucie County contractor license number and
the name of the business doing the work.
6. Val IIe of Construction . Indicate the total value of the work to take place. Total cost
of construction includes all current.retail material 'slid 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 that
the submitted figures are not consistent with similar types
of construction.
❑ G . S Attach 2 piping schematics with tank size, location, and BTU of each. appliance
ITS ed: Attach 2. plot plans, 2 copies of DCA letter and plans, 2 anchor specifications
❑ F ,nce Attach 2 plot plans showing location of fence height of fence and type of fence
❑ Siding Attach 2 copies of manufactures specifications t
❑ B VAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts foi
new system or full replacement
This a placation can be submitted to St. Lucie County Building and Zoning. 2300 Virginia Avenue, Fort Pierce,
FL 34 6 82. All permit applications must be filled out completely before submission. No applications will be
accep d for processing after 4:30 P.M. For assistance in completing this application, please call (772)
462-1 �53, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
.. �1 - r.,_._-..__:. _,.,.. ;. 4 ;,,c„P,.t;r%nc ran he scheduled by calling (772) 462-1261.