HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONSt. Lucie County Building & Zo
2300 Virginia Avenue FtPierce,rl,34982-5652
Tel. 561-462-1553
SPECIALTY PERNHT APPLICATION
SCANIVED
BY
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Seepage 2for instructions and additionalpaperwork requiredforspecialty permits
1. Location/Site Address:
2. Parcel ]ED Number:JWo? - &6) q - zt&4- - om
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of Project or Work Activity;
4. Owners Information
Name: bmid ir Wri,
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City: �'tate: r-1
Zip: �qq 9L) --2r7A
TWI Phone: ?'(U �JDV
6. Value of Construction: $
S. Contractors Information
FL Reg/Cert #:
County Cert#:
Business Name:
OWNER'S AFTIDAVIT: 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 regul '
PRINT QUALIFIERSIOWNERS NAME
STATS Or FLORIDA, COUNTY OF
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TITLE: No'rARY PUBLI
IS PERSONALLY
CO M M IS SI ON NUM il PR
OrQUALIFIERIOWNrR
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Mr. OR WHO HAS PRODUCED
My COMMISSIDN 0 DD 852557
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SL Lucie County Specialty Pennit Application rev. 8/25/05 ding