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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONPlanning & Development Services Building & Code Regulations Division 2300 Virginia Ave. SCANNED Fort Pierce, FL 34982 BY (772)462-1553 St. Lucie County SPECIALTY PERMIT APPLICATION Electrical ❑ Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Addressrr�� �� y�Ur�� LM©IC(/1 1-f-w�^DY�t-LL-�,s� `i - n ep 2. Parcel ID Number: S, I ()� /J ^ 0on q 3. Office Use Ind Township Range Map Page Zoning Land Use Initials only Complete Description of Project or Work: Rom\ ���C"'e2 Sw )-rP/4� 4. Owners Information( 5. Contractors Information Name: \�^ fY\ ii^l''i�Tl�� (Me4 1120 21 one Address: �� ` coLU\ l".` moDeLL �b City: e- State: �Q FL Reg/Cert #: County Cert#: Business Name: EC #0002956 19055 JAK, Inc. d/b/a Applebee Electric Zip: �Jyq� Phone: 1 r — 57 Phone: (772) 466-7930 Fax: (772) 466-3765 6. Value of Construction: $ �Q� OWNER'S AFFIDAVIT: I compliance with all applicable laws John M. Applebee STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE METFBS�DAY ��o BY �� WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED AS IDENTIFICATION. )'Ty �)ES: (seal) .: 530 ARY TYPE OR PRINT NA OF O ARY' .�` Bonded Thm Not o waters COMMISSION N ER 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 1 Revised 04262010 A