HomeMy WebLinkAboutSPECIALITY PERMIT APPLICATIONFee Due: i Receipt# Permit # / D Q
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
1 Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ SCANNED
Electrical ❑Plumbing ❑ HVAC ence BY
❑ Shed ❑ Demolition ❑ Gas Siding St. LucieCoanty
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: .
2. Parcel ID Number: � � � J D �' 6 �� — (0 0 6 —3
Office Use
Section
Township
Range
Man Page
I Zoning
Land Use
I Initials
Only
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3. Description of Project or Work Activity:
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4. Owners Information / 5. Contractors Information
Name:—r z "vrii�oz- r FL Reg/Cert #:
Addr 55(,l WLOAVI y;� County Cert#: 35a
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City: State: F6- Business Name: l �ha—V-,YfY1a4i rien iP
Zip: PhMi p?•�%%� Phone37O' Fax ' -W-3a l U
6. Value of Construction: $ O
OWNERS AFFIDAVfr: 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,
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PRINT QUALIFTERS/OWNERS NAME IER
/ �� �' n SIGNATURE OF QUALIF/OWNER
STATE OF FLORIDA, COUNTY OF , t"i (N' ACKNOWLEDGED BEFORE ME THIS 2-1 DAY OF
20_iBY J5—yA94!2dr10 C W IS PERSON. ALL_ Y� 11O ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
(seal)
SI A OF NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER "
y1l1•00 "U09 opua0V MU papuoR
010E `ZZ -UM :saaidxgA
St. Lucie County Specialty Permit Application rev. 8125/05 dmg TWIESQG # 110I IU1E10 )
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