HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION - SIDINGPlanning & Development Services
Building & Code Regulations Division SCANNED
2300 Virginia Ave. ��
Fort Pierce, FL 34982
(772)462-1553 St. Lucie County
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence \O
❑ Shed ❑ Demolition ❑ Gas g Siding
Seepage 2 for iinsiructious and adaionalppapenvork reguiredfor specialty permits
1. Location/Site Address:��,�'�✓ji2I J P.(CQ,t FL 34 95/
2. Parcel In Number: I �' O (! i C)OOCI - 000'
Office Use
Section
Township
Raoge
Afap Page
Inning
Land Use
Inldah
Only
P1
ISci
S
3. Complete Description of Project or Work:
4. Owners InformadonS�PlV,,-,,e- 5. Contractors Information
tun r0WjeC FLReg/Cert#: Gb° 1��
19
Name: &
Address: SHOO C- ql eP v r
City: r'f. Ple�� State: I �.
p ZZZ �b�L Zip: 4 I � . Phone• '
6. Value of Construction: , oco P J
SC-
County Cert#:
Business Name: '2 �f�G.J(I�JICiSSmp�(� �fS�l'(YALYIc (�.�
Phone•71J'l{%J-LfIIFax:17;.'779-05�YQ Cl
OWNERS AFFIDAvrr: 1 certify_, that all of the information contained in this application is co and that all work will be done in
compliance with all applicable laws regulatln 1 n an
PRINT OWNER OR CONTRACTOR NAME, _ TURE OF OWNER OR C TRACTOR
STATE OF FLORIDA. COUNTY OF .iC�f//� (`�1 _
ACKNOWLEDGED BEFORE METHIS I2v DAYOF 20 Z /. BY�y N/]
WHO IS PERSONALLY KNOWN TO ME_ OR WHO HAS PRODUCED J"L S�IJ �VI
IFICATION.
_ L 4, rYl �Q� Q
SIG OF NOTARY
COMMISSION NUMBER
TYPE OR PRINT NAME OF NOTARY
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL7
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FI
LENDER OR AN ATTORNEY BEFORE RECORDINGYOUR NOTICE OF COMM
EXEMPT: A!C-HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010