HomeMy WebLinkAboutSPECIALITY PERMIT APPLICATION1. i o
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Permit
0 Electrical
❑ Shed
St. Lucie County Building & Zoning
2300.Virginia Avenue FL Piene, FL 34982-5652
Tel. 561462-1553
SPECIALTY PERMIT APPLICATION
❑ Plumbing ❑ HVAC 6 Fence.
❑ Demolition ❑ Gas ❑ Siding
SCANNED
BY
St bUclor.minb
See page 2 for instructions, and additional paperwork required for specialty permits
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1. Location/Site Address:
2. Parcel lDNumber:��9—S30—D�/�
Ot'tice Use '
Seciion
Townshi'
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'1VIa Pa a
Zonin
Land Use
Initials
Only
24
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3. Description of Project
4. Owners In ligation Contractors Inform4t1'opn,
Name:P3FILReg/Cert#: /°/''i
Address: ((I�C's'�ulc� County Cert#:
City: vY�Dil (57�%.�Zi State: 0>cA,) Business Name: pp�� f � /��
Zip: IJTeF� l rione:��3'2��%/ 91 Phone&P,2eaF/�Fax ?& �'�% 6 Pi
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6. Value of Construction: s . aol7
OWNER'i'aiFIDAVIT: 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 constructi n andzoning.
RASS A. CHAMBERS /
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIERIOWNER 7711/
STATE OF FLORIDA, COUNTY OF,/ A�CKNOOWLED�GED BEFORE ME THIS � DAY OF
/i/nn ADO nnn% nv /yX'S Xt L%f WHO 1. BPS F.RSONALLY KNOWNYO ME OR WHO HAS PRODUCED
NOTARY
TITLE: NOTARY PUBLIC
St. Lucie County Specialty Permit Application rev. 8/25/05 ding
TYPE OR PRINT NAME OF NOTARY
COMMISSION
NUMBER
p"'•""•,
VICKIE MALCOLM
Y: .r
MY COMMISSION p DD 408558
••, a
EXPIRES: Aptl120, 2009
BWftl ThN NOtwy Pubic Underwriters
(seal)
NOTICE TO OWNER: FAILURE TO 1,::�6RD A NOTICE OF COMMENCEMENT MAY tc�sSLT 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 $5,000.
INSTRUCTIONS
Please complete all infon-hation.in the space provided. All information mustbe printed (use black or blue ink
only) or typed. This permit application is to be used only for those activities that are not otherwise included
alteration. The information to be provided with
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or Work Acti''ty
4. Owner Information
includes:
Indicate the street addressor general location of the
property where the building activity is taking place.
Indicate the tax identification number of the property
'where the building activity is taking place.
Fully describe the activity to take place. ,
Indicate the name and address of the owner of the property
on -which activity'is taking place.
5. Contractor Information Indicate the State of Florida registration number (if
applicable), St. Lucie County contractor license number .
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 labor
costs associated with the building/construction activity.
Construction value is used to determine the permit fee. St.
Lucie County reserves the right to question and/or modify
the indicated value of construction if it:is demonstrated that
the submitted figures are not consistent with similar types
of construction.' .
Gas Attach 2 piping schematics with tank size, location, and BTU of each appliance
❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans; 2 anchor specifications
0 Yen m . " Attach 2-plot plans showing location of fence height of fence and type of
❑ Siding Attach 2 copies of manufactures specifications
❑ HVAC 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 to St. Lucie County Building 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.
NOTE. Emergency electric service change out inspections will not be performed after 3:00 PM without
special arrangements and.a_ddit`ronal fee.paid.
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Upon issuance ofthis permit, required inspections can be scheduled by calling (772) 462-1261.
St. Lucie County Specialty Permit Application rev. 8/25/05 drug