HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONf -
Date: M QL IA-1 I Fee Due: Receipt# I r-erinit # i116 -Or 12,
Planning & Development Services
Building &Code Regulations Division RECEIVED
� SCANNED 2300 Virginia Ave.
• t BY Fort Pierce FL 34982
5t. Lucie County (772)462-1553
OCT 25 2017
SPECIALTY PERMIT A ICATIOZ4
Permitting
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence St. Lucie
❑ Shed ❑ Demolition .(Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialtypermits
1. Location/Site Addr
2. Parcel ID Number:
3.
4.
3t S (fS ! f ! = PA.,fu 01fD Af&r9
Department
County, FL
Office Use
Section
Township
Range
Map Page
Zoning
Land Use
Initials
Only
Description of Project or Work: )AIRZO R— If gh'Ml. (A Wi{S 7d
for) ➢ALA I, CAP—r% _ DA411'e13 � t^Pi/C P-a
Owners Information 5. Contractors Information
Name: p,
0'q
City: State:
Zip: J"( % Phone:
6. Value of Construction: $ J VV
OWNER'S AFFIDAVIT:
�C /n� II,, [cn, ,coL RINT O
compliance with all applicable laws regl
l
! Ptty Nv of 1WNER ORN NAME
s6d
FL Reg/Cert #: / V24/
County Cert#: ((��,,, z(( w
R'Ot. Business Name: Q /oe - gj&/ r'fir,
Phone:77a'Z2a-iI�7FaW
STATE OF FLORIDA, COUNTY OF MM li
ACKNOWLEDGED BEFORE ME THIS AY OI)�Y„ 20—La, BYC*E!4ft`s�Iv
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFIC kTION.. :��L:: ALYSSA ATKINSON
y�y MY COMMISSION #FF117904
:?o. h�"•` EXA RCS June 9, 2018
SIGNATURE OF NOTARY %] TYPE OR PRINT NAME OF NOTARY (407) 3e-0 9153 FlorldaNco otaryService.m
COMMISSION NUMBER F�/! iaO-Lj
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 04262010