HomeMy WebLinkAboutSPECIALITY PERMIT APPLICATIONDate:
Due:
Permit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC UFence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: \/i 1k0- Z)2\ Zak - 11000 S oC QCt CAQ
2. Parcel ID Number: t`1519.-701 - C)QQQ- CX'70—O
St, uc Co. FL t
Dal t
SCANNED
BY
St. Lucie County
Office Use
Section
Township
Range
Map Page
zoning
La Use
' ials
Only
I ON
3. Complete Description of Project or Work: I ol}i / n-1- (� G5-r, cy"na:i k W / U.) ct L
4. Owners Information 5. Contractors Information
Name:y' 1 `C" �Q� �j� FL Reg/Cert #: t t 14
Address: (k``000-) S OCQCL c\ if; IJ-P County Cert#: cZ 09 7 �i City: State: TL— Business Name: SA'-'/�Ook 1-.2Mo C CMlg'��'./
Zip: 3 I (q S-7 Phone: 22 Phone: a gS- I l Sl H'ax: a g g -30
6. Value of Construction: $ 0 38-6 -00
OWNER'S AFFIDAVIT: I certify that all of the information contained in this �P,] lica 96 S co!Tect . that
compliance with all applicable laws regulating c strut' . nd zoning.
PRINT ,,,.+E--R-eR CONTRACTOR NAME S[GNA' RE 9G 8U41&R OR ONT ACTOR
STATE OF FLORIDA, COUNTY OF d A
ACKNOWLEDGED BEFORE ME THIS DAY OF ,20_�BY C1"IZKC T 1\iCanrY�CJf� -
WHO IS PERSONRKNOW70E— OR WHO HAS PRODUCED
AS IDENTIFICAT o�p;(�ti •. JI BUFORD
r„,�t, !�
J; u •( p,1,f i•� MY COIiASeMy)SSION #FF076468
GNATUR TARY TYPE OR PRINT NAME OF NOTARY ?���o;333n`j EXPIRES December 12. 2017
SI
(4e7)39"IM F1.,,dallo1aryService.com
COMMISSION NUMBER
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 0426/2010