HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION- -- - -- ••�•.�• •� a mod- rermu st
? St. Lucie County Building 'oning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
�Rtp Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
SCANNED
By
❑ Electrical ❑ Plumbing ❑ HVAC C3 Fence St. hiceCouPlty
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
I. Location/Site Address: - • 3 q) S. & ' S, J-
2. Parcel ID Number: 2 9z -? - (01 - Oo Y S-- 660 -
Offiee Use
Only
Section
T
Zon
nd Use
Initials
1
c�1i a1
1 l—
CO
3. Description of Project or Work Activity:: Y �t 0� CW nL'yik 1' n p
and ZoC) %GF' a ' IJeBeI i Q vte� 7. 16 C f
c5a:e U re I l agFe
4. Owners Information /I '5. Contractors Information
Name:- N l ka l e o'g .. karo rJL► I /tas FL Reg/Cert #:
Address: 2 ,VC . T_ C
Dr County Cert#:
City1 r- State: Fl - Business Name:
Zip:S S Phone: Phone_ Fax
6. Value of Construction:
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 and zoning.
�r-
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF 5-1 • !„L t n C C' (-� ^ ` —ACKNOWLEDGED BEFORE ME THIS 1 � DAY OF
t\� C)V . 20Q-5 BY t�f Ci I () C V [l rrC WHO75 PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS I(/IJ','E�)1hTIFICATION. ��• Q t7�/�� � � d , �� Uc d
_ `til1At. I 1 tf L'iC� t / (seal) .
SIGN tTURE OF N ARY TYPE OR PRINT NAME OF NUTARY"""`: Beatriz Serrano
�tr3!YP ��
, '�'••': Commission 4DD228304
TITLE: NOTAR PUBLIC
COMMISSION NUMBER =°?� Expires: Jul 01, 2007
?• ' %06 w Bonded TF
�'`' Atlantic Bonding Co., Inc.
St. Lucie County Specialty Permit Application rev. 7/IS/05 dmg
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMEN'' YOUR PROPERTY: IF YOU INTEND TO OflT `$N FINANCING, CONSULT WITH YOUR
LENDER OR AT ORNEY BEFORE RECORDING YOUR NOT, TF COMMENCEMENT. ar,
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDEK zS;000.
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or blue ink
only) 6f t'yped. This permit application is to be used only for those activities that are not otherwise included
under a primary building permit. This application may not be used for any activity that includes structural
alteration. The information to be provided with this application includes:
1. Location/Site Address Indicate the street address or general location of the
property where the building activity is taking place.
2. Parcel ID Number Indicate the tax identification number of the property
where the building activity is taking place.
3. Description of Project or Work Activity Fully describe the activity to take place.
4. Owner Information Indicate the'name and address ,of the owner of the property
on which activity is taking place.
5. Contractor Informatton Indicate the State of Florida registration
number (if
applicable); St. Lucie County dontractor license ntYmlier and
the name of the business doing the work.
6. Value of Construction _ Indicate the total value of the work to take place. Total cost
of construction includes all current retail material and Iabor
costs associated 'with'th&-Building/cotistr 6tion activity.`
Construction value is used to determine the,permit fee. St.
Lucie County reserves the right to question and/or modify
the indicated'viii6e of construction if -if is`dernonstrated that
the submitted figures are not consistent witb,similar types
of construction.
❑ Gas Attach 2 piping schematics with tank size, locatipp` and BTU of each appliance
❑ ed: Attach 2 plot plans, 2 copies of DCA letter and plans, Tanchor specifications
Fence Attach 2 plot plans showing location of fence height of fence and type of fence
❑ Siding Attach 2 copies of manufactures specifications
❑ $VAC Attach 2 residential energy studies, 2 manual J calculations.2 sets of duct layouts for
new system or full replacement
This application can be submitted' lo'StrLucie Couritht:l3Aildin' and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 34982. All permit applications must be filled out completely before submission. No applications will be
accepted for processing after 4:30 P.M. For assistance in completing this application, please call (772)
462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.
St. Lucie County Specialty Permit Application rev. 7118/05 dmg