HomeMy WebLinkAboutSPECIALITY PERMIT APPLICATION - DEMOLITIONA • %\ Luc. IitCl:Cl lit rermtt iF
y St. Lucie ',County Building " .!, *.ning. - -
2300. Virginia Avenue Ft. Pierce, FL 34982-5652
R10 Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ P xlmbing ❑ HVAC ❑ Fence
❑ Shed Z&molition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits oe',
1. Location/Site Address: Z&P_IAIt)
2. Parcel ID Number:
wl �4
Office Use
Only
Section
Township
Range I
Map Page
Zoning
Land Use
I Initials
12 a
a
3. Description of Project or Work Activity:
4. Owners InformationS. Contractors Information
Name:
/�/ 1
� %'�'l�i ��/�� FL Reg/Cert 62
Address:���: CS;�),-AZWZ,,0L1z ,County Cert#: d,314 1
City: /,/,��7 State: Business Name: Cx?
Zip: Phone: �hole�� C�Fax
6. Value'lof Construction: $ i '
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.
I,
PRINT QUALIFIERS/OWNERS NAME) SIGNATURE OF QUALIFIER/OWNER
STATE
OF FLORIDA, COUNTAdt/AACKNOWLEDGED Y OF /''ftBEFORE ME THIS iG/� DAY OF
•'20LK! BYE"` l W11'-��&0EllS ERSOLLY KNOWN TO ME OR WHO HAS PRODUCED
~ ( AS IDENTIFICATION.
1
(seal)
SIGNATURE OF -NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: N COMMISSION NUMBER 04/;� _�
SHARON KRULL ROSE
i .; MY COMMISSION # DO 3SM!7
EXPIRES: December 3, 2008
Bonded Thru Notary Public Undenvdllre
St. Lucie County Specialty Permit Application rev. 7/18/05 dmg
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RES?n T IN YOUR PAYING 1 w1Gb rL)K
IMPROVEMENTS' 'OUR PROPERTY. 1F YOU INTEND TO OBTAII ANCING, CONSULT WITH YOUR
LENDER OR AN A'_ = tNEY BEFORE RECORDING YOUR NOTICE 01' , �,MMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT'WITH CONTRACT UNDER $5,000.
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or 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 generallocation 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 J
i tion of Project '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 activity 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:retail material 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 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 of fence height of fence and type of fence
® Siding Attach 2 copies of manufactures specifications
❑ 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 P.M. For assistance in completing,this.application,,please call (772)
462-1553, during regular office hours (8:00 AM - 5:00 PM) on. through Friday
Upon issuance of this pennit, required inspections can be sclieduled�by;calling,:(772)462 1261.
St. Lucie County Specialty Permit Application rev. 7/105 dmg