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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION - DEMOLITIONI Date I )IL-LPee Due: Receipt# t Permit # ML F L Rt?1-i—W l'$`D'orA Planning & Development Ski v4e`eg Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 S SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ RVAC ❑ Fence ❑ Shed ® Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: -4 I o 3 Qs�Sa � b `es Q\ V 2J 2. Parcel ID Number: 01 - 611 - CC) r. ?> ~ 000 - 2' SCANNED BY St Lucie County = � WIR ��=Elfmvfiw 3. Complete Description of Project or Work: OF �eK<< 4. Owners Information 5. Contractors Information Name: -71 5Ay+�UGICCbI)Oic-i FLReg/Cert#: Address: � 4 3� (i 7-I ✓1 6 t County Cert#: City: �©J E? 1(?kCO— State: f l�- Business Name: GGc- (S( 6:4NS 0, ';� ©off COOIS�QUGitOUSUiceS Zip: 34 C( 96 Phone: Z ( 6 - 3 O Phone:5 19-24 4 J Fax: -3 316 - R 3 4 9 6. Value of Construction: $ 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. (4A03 PRINT OWNER OR CONTRACTOR NAME - SIGNATURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF —AL Q(u e /�1/n/ /1 /�/I� ACKNOWLEDGED BEFORE ME THIS�5''` DAY OF IL�O.ia QuM�' 20,�1 ,BYE /tOL(./U.CLO O�II%DYazn WHO IS PERSONALLY KNOWN TO MEJZOR WHO HAS PRODUCED B,S IDENTIFICATION S NATURED YNATUREO YY COMMISSION NUMBER pury Public - Ste@ 01 RMM Comm. Expires Jul 29. 2016 Commission • EE 209535 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 04/262010