HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
Fee Due:
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
Electrical-
❑ Plumbing
❑ HVAC
-- ❑ Fence
❑ Shed
❑ Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
�AANNED
By
St. LucleGoonty
1. Location/Site Address: 5Q11 J�7I \N111DQDNrl�I`IIAVU PLYCd,{� D A bLi�n
2. Parcel ID Number: �� L - b b I " 0C1 D -0a)-
Township
Range
Map Page
Zoning
Land Use
Initials
0/ice Use
Section
Only
/
//
1p S
7 p
3 a
3 a- i� X
G,Z
G �'
CA
4. Owners Information T 5. Contractors Information
Name: Al o 11 [6 11 , I eresQ IAQM _ FL Reg/Cert #:
Address: ,/�1�-I 8J w h' JJ013y1 U� � i {��C?({1Q County Cert#:
City: 1��Pf (,(Lc State: Y � Business Name:
Zip: U -1' 0 Phone: yagnphone-
6. Value of Construction: $ 8f Jy • C)o
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 z in
PRAT OWNER OR CONTRACTOR NAME r SIGNATUREOF OWI� RO CO TR TOR
STATE OF FLORIDA, COUNTY OF ,)'1' 0r � �/"�
ACKNOWLEDGED BEFORE ME THIS_-_�DAYOF ,2019 ,BY (�-i.'(r.hpef R6L)(,kVW
WHO PERSONALLY KNOWN TO ME —OR WHO HAS PRODUC
AS ID NTIFICATION.
�pO I& Notary Public State of Florida
VL{/ G{ (.(� Q ?�'�; Antos Paula
S A E F NO ARY TYPE OR PRINT NAME OFNOTARY '�c �� My Commission EE068021
?or no Expires 0212712015
COMMISSIONNUM, ftugu
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 $7500.00
Revised 04/26/2010