HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: c AAFee Due: �' Receipt# It{ 3]
Planning & Development Services,,
Building & Code Regulations Division •
2300 Virginia Ave. RECEIVED
Fort Pierce, FL 34982
(772)462-1553
SAP 2 8 2018
SPECIALTY PERMIT APPLICATION I ST. Lucie County, Permitting
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition JZGas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: `7iO4::O ' '/(J*5 —
1/
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office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Descripgon of Project or Work:
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4. Owners Information , 5. Contractors Information
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Name:�) in
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Address: c�o-
City: �/ (/L State: FL-
Zip: (} Phone:
6. Value of Construction: $ 320"
FL Reg/Cert #:
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Wk
County Cert#:
Business Name:
Phone: T '270- ax•
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.
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PRINT OMER OR CONTRACTOR NAME S RE OF OWNER OR CONTRR CTP R
STATE OF FLORIDA, COUNTY OF ►!yy' t ' U r
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 I OG � , BY( 3yQf )r)a- I -- W(Sdn
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
A ENTIFICATION.� Jenna Glebe
• = COIUNVIISSION # OG24M
SIC& URE OF NOT TYPE OR PRINT NAME OF NOTARY �� *�
�` ;,�r� ;EXPIRES: August 13, 2422
COMMISSION NUMBER Cep ��u�Ti11+�� Bonded Thru Aaron Notary
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 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.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010