HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONe: I f '� / / fee Dne: Recei t# Permit #
Plauing & Devmeat Services ry /✓!� n �03�
a " Building& Code R atious Division
2300 Virginia Ave:
- - Fort Pierce, L 34982 AdqNtlC�n
(772)462=1553
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SPECIALTY.PERMIT APPLICATIOAT fit. �ilC1E GOUTY
JXElectiical ❑ Plumbing ❑ HVAC ❑ Fence
0 Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for invtracdons and additional paperwork regaired forspeciaV permits
1. Locatlonisite Address: I 1 t7 3 T; I +o r. 1-� c _For, i- St • L u c', e- , F 1- 3 (4 9 5 a
2. Parcel M Number. 3 `114 - 5 O) - 07 0 `l - 000 - 3
office Use
Secdon
Tosmship
Range
Map Page
Zoning
Land Use
Initials
0*
3. Complete Description of Project or Work: ISO, 4,nl Suvrce to Ga�aq e
4. Owners Information 5. Contractors Information
Name: C w. I -')eSS a rn e C- FL Reg/Cert#: F C OOo 19 (03
Address: 110 3 I ; I to n (� a • County Cer(#: I'7 (.9
City: tort 1�'- T e r r e State: F L Business Name: 3 i ch ma n) C I e ct c i G
Zip: 34 wB L Phone: 22�- ao l-3y96Phoue:-7*72-ytO -11S) Fax: -77 Z - yEJ -i c109
6. Value of Construction: S S U C,?. rr
owNm,s AFFIDAvrr: I certify that all of the information contained in this application is correct and that all work WIil be don,
compliance with all applicable laws regulating construction andzoonin_g.
C�nr;StoPher I..� �;chr-.end �l/✓.�✓�.
PRINT OWNER RCONTRACTORNAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St • L ti C .. e-
ACKNOWLEDGEDBEFOREMETIUS 30 DAYOF -:S�.kV 20 JS�BY Onris+veher R chr-ar )
WHO IS PERSONALLY KNOWNTO ME /\ OR WHO HAS PRODUCED --
AS IDENTIFICATION.
SIGN OF NOTARY
COMMISSIONNIIMEER EEII BSA
CASI�X�BINKLEY
MY COMMISSION # EE117856
EXPIRES August 16, 2015
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 WITS CONTRACT UNDER $1500.00 \\\
Revises oanenolo 1 ��