HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONt
Date: I Fee Due: Receipt, Permit
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34932
(772)462-1553
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SCANNED
BY
St. Lucie County
SPECI_NLT ER'YIIT APPLICATION
ElElectrical ElPlumbing �AC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 jor instruedons and addfdonal paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: I`
3
4. ow
Name:
Address: U I l
City: N
Zip: w
6. Value of Construction:
OWNER'SAFFIDAVIT: fee!
State: h
Phone: '
5. Contractors Information /� _ �O
FL Reg/Cert; Cl(��1.
County Cent;.:
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Businn sss{NTameeL:.j��(\ � Vl 1�
Phone. lr7 fix/ Fax:
that all of the information contained in this appl' ation is
ice with all applicable laws regulating consrruq6on&id z
done in
STATE OF FLORIDA. COUNTY OF
ACKNOWLEDGED BEFORE :ME THI - DAY OF
WH IS'ERSON MOWN TO R WHO HAS PRODUCED
.AS I FICATIO t TRACY i.ANGEL
I NOTARY PUBLIC
siG TYPE OR PRIM OF N v STATE OF FLORIDA
cc MlssloN NOm 1,arar Comm# EE021921
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NOTICE -TO OWNER: FAILURE TO, RECORD A NOTICE. OF COMMENCENIENT MAY RESULT IN YOUR PAYING TWICE FOR
IMP.ROVEMENTS,TO' YOUR. PROPERTY. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR
LENDER:OR,AN,ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EYE.MPT: A/C-REAT-REPLACEMENT WITH CONTRACT UNDER S7500.00
Revised:04/252010
1/19/2013 13:28
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SEACOAST AC .1
PAGE 02
❑ Electrical
❑ Shed
See page
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce. FL 349S2
(? 2)462-i553
SPECI:VA
ERIMIT APPLICATION
❑ Plumbing ❑ Fence
❑ Demolition ❑ Gas 0 Siding
1. Location/Site Address:
2. Parcel ID Number:
3.
0
4- Owne form ti n
Name:
Address: ti
City: (�
Zip: -jtQq`l
6. Value of Construction:
OWNER'S.%FFI➢A`/Tr;
Revived Oar Si20111
BEFORF, CIE
and additional paperwork required for specialty permits
s. Contractors Information (1� pO ���4�
FL Re�Cert �C71/�'�, �7J
7 County Cert�: aS5
State: , Basijn�f58NAHIC �
Phone:. Phon�C.1-et.UIYW Fax: ` �/(e(P* ZQS�.
Rich ail applicahlc laws
iv )AY'!iF
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m
TRACY LANOEL
Y1'4 UK :'IUNf vAlA1E OF NOWY STATE OF FLORIDA
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n: FAILURE TO RECORD A .NOTICE OF COMMENCEYIENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEyiE-NTS TO YOUR. PROPERTY. M YOU INTEND TO OBTAIN FINANCiNO. CONSULT -IT'.t YQIin
LENDER. OR:.jS- ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT,
EXEMPT:.UC.1tEA•TREPI:.if.EMENT WITH CONTR'ACf UNDER 3-900.00