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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONr M Planning & Development Services Building & Code Regulations Division SCANNED 2300 Virginia Ave. BY Fort Pierce, FL 34982 St. Lucie County (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 for iinstrucdons and additional paperwor_kk required for specially permits ` 1. Location/Site Address: 1 Q( ) � C �ja I I!)' 2. Parcel ED Number: 3. 4. Name: Offrc_ Use Section Township Range Map Page Zoning Land Use Initials Only Description of Prgiect or 5. Contractors Information FL Reg/Cert #: Address: 1. A=U-) ((L�51_k/ rn City: C r I? state: 1 I 1 foOO Zip: I Phone: 6. Value of Construction: $ OWNER'S AFFIDAVIT: I certify that all of the intbrmation c compliance with all applicable laws STATE OF FLORIDA, COUNTY OF - - ACKNOWLEDGEDBEFOREME TIES WHO PERSONALLY KNOWNTO MEN— OR WHO HAS PRODUCED AS CAON. T racy LANOEL TracyTracy LanelNOTARY1P LIO pTURE ARY TYPE OR PRINT NA, :OFNOTARYSTATEO ORIDA Comm# EE021024 COMMISSION ER EE 0 21 9 2 4 County Cert#: Business Name: Phone:466-2400 m 1 a plication is c cion 1TURE OF_ ORC( 8283 SEA COAST AC 772-466-3053 that all work will be done in i i BY JOHN V LANGEI, 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 57500.00 Revised 04/26/2010 Planning & Development Services Building & Code Regulations Division ■ 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION M Electrical ❑ Plumbing ❑ HvAC O Bence ❑ Shed © Demolition ❑ Gas ❑ Sing See page 2for mstrardans and additional p4perwork required for specially permits I. Locatlon/Sife Address; 2. Parcel ID Number: 3. cram, IL 4. ownf Name: Addrm: City: 116 Ojjlrr LAse Only Saeaon Towaaldp Range Map Page Zoning Land Van Initiay _ i ilk or Contractors rafarmatian l FL Reg/Cert #; County Cell#: State: I I 1 Business Name: Zip: Phaone: 6. Value of Constructiou; S OWNERS will all applicable laws JOHN V L-,Near PRINT OWNER OR CONTRACTOR NAtv11- ACKNOWLEDGED BEFORE ME THIS ICA DAY OF WHO PERSONALLYKNOWNTOME—_ OR WHO HAS PRODUCED AS ITIFICAnON. j Y'MOY LANGEL Tracy Lan al w No'ARYIP LIC A7 ARY TYPE OR PRINT NA.NEOFNOTARY STATEd FJOA COMMISStoN ER EE021924 0 Comm#E80Z182,4 E)plms 8=/2014 NOTICETOOWNER: FAILURE TO RECORD a NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING, TWICE FOR 1MPROVENLENTS 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 SIS00.00 R"iud 04126r_010 SEA COAST AC Phoae:466-2400 Fax: 772-466-3053 20 tip/ �eY _JOHN V LANGEI; done ZO 39Vd OG 1S000V3S E90699VZLL ZO:bT ZLOZ/IL/Zl