HomeMy WebLinkAboutSPECIALITY PERMIT APPLICATIONY. t� _
Date:I Fee Due: Receipt# r �` Permit #
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Planning & Development Services
Building & Code Regulations Division 2300 Virginia Ave. SCANNED
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Fort Pierce, FL 34982 BY
(772)462-1553 St. LucieGoafl4v
SPECIALTY PERMIT APPLICATION
19 Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: _I C) r1 DO \ 5 • of -PAP Y1 Q (— -
2. Parcel ID Number: 4-0 Ids— J � I
Office Use
Section
Township
Range
Map Page
Zoning
land Use
Initials
Only
3. Complete Description of Project or Work:
4. Owners Information 5. Contractors Information
Name: ' E F T X LL- FL Reg/Cert #:
Address: 41545 N0(en ) kx County Cert#:
City: J P nf5e�State:
Zip: 3y',9 �rl Phone: Oa—li3` �110-1-\
6. Value of Construction: $ "�') ) W0
EC oo0oc)-2-3s
Business Name: (= 1 P_.C_ (� r�nnQ ��y�
5u 1 5(RI
Phone: 5ab-(o�9 Fax:_ U (o -cl S �t
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 pnd zoning.
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PRINT OWNER RCOT I LACTOR NAME SIGNATURE PF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF f'-)T • L l) L,.,y
ACKNOWLEDGED BEFORE ME THIS--A—DAY OF II I°, 20 13 BY I�q,�c�U S\0� ay6trn-)
WHO IS PERSONALLY KNOWN TOME %// OR WHO HAS PRODUCED — SITYANL BHOMELOW
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ASI �T`J}�H''\t \j ON�. (^j �/��/ � _.; :.= M1IYCOMMISSION YEE034959
� �'•9„'";t�;R'�`- EXPIRES: October
XPIiES:Oclober 17, 2014
TnN NalaryPublic Undenml Y-1
SIGNAT Y TpRrNNAME OF NOR
COMMISSION NUMBER r V.
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 S7500.00
Revised 04/262010