HomeMy WebLinkAboutSPECIALTY PERMIT APPICATIONTo: Saint Lucie County Building Department Prr^ F of 7
2012-02-16 22:24:49 (GMT)
17726735762 From: DAVID KRUSE
❑ Electrical
❑ Shed
1.
2. Parcel IDNumber:
3.
Piapniag & Development Services
Building &"Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982.
(772)462-1553
SCANNED
BY
St. Lucie County
SPECIALTY PERMIT APPLICATION
❑ Plumbing AHVAC ❑Fence.
❑ Demolition ❑ Gas ❑ Siding
and addWonaf"paperwork requiredjor special* permits
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Liy'ji[c t1�4
.5'c flan
Tqn--hip
Range
Map PDRk
Zoning
Land Use
Initials
out),
4. Owners Inform` ation nn 51.. Contractors Information
Name: ST I ul1C TI4 � 6 � F"LReg/Ccrt#: CAC" .S uPL
:N T _ ...1
Address W ()l Qt1'/6\4s," 44
f'EountyCert#:
Cit State: ItusinessNamc: O r
Zip: 222 'OCS .. ..
6. Value of Construction: S
OWNERIS.AFFI,nAYIT: 10,"-Fythat all ofthe information contained it
compl iance with all applicable' laws regulating
PR� OR CQNTRA M RNAME SIGNAL
STATE OF FLORIDA, COUNTY OF',
=—�CifNOWLDtiGED'DERORE`F]ETlll$—DAYbf+----20_,.RS —` —
WHO IS PERSONALLY KNOWN To ME_OR WHO HAS PRODUCED
-' A$. 1DEN1717CAT10N.
$IGNATURE OF NOTARY
COMMISSION NUMBER
lNOT10ETOOWr%W FAILURE TO RECOR
IMPROVEMENTS TO
LENDER OR AN ATTO1
EXEMPT; A/04IEAT REPLACEA
Revised 04A641010
TYPE OR PRINT NAME OF NOTARY - (seel)
OF COMMENCEMENT MAY RESULT IN YOUR, PAYING TWICE FOR
TY, 1F YOU. ;INTEND TO ,OBTAIN- FINANCING, CONSULT -WITH YOUR
CONTRACT
Date Fee Due. Receipt# 'j Permit # 1-
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 foorr{insttrruuctions and addit%ion�al paapeerwork rreeg1uui1}reear folrNsp1eciiaalty permits
1. Location/Site Address: 31 W��`` o Cyr 1 ' (A �"�`"
2. Parcel ID Number: 1"Il.l1 ✓ (go M C
Township
Range
Map Page
Zoning
Land Use
Initials
0(5ce Use
Section
3
4. Owners Information 5. Contractors Information �, j
Name: �
c FL Reg/Cert #: 4
Obqq
Address: � County Cert#:
City: <SE1� State: Y-{— BusmesName:
Zip:'Nn C Phone:�bane`f1410 `a ) Fax:
6. Value of Construction: $ C/tTILJ
OWNERS AFFIDAVIT: I certify that all of the information contained' is application is orrect and at a0 work will be done in .
compliance with all applicable laws regulat g c nstruction and ing.
3w `�-�fflw d/ t
PRINT OWNER OR CAN RACiORN a SIGN OFO ORC RACTOR
STATE OF FLORIDA, COUNTY OF - -----
(� TRACY LANGF_L
ACKNOWLEDGED BEFORE ME THIS /1 DAY OF VI •20 'BY �U �" � NQTARY PUBLIC
WHO IS PERSONALLY KNOWN TOW OR WHO HAS PRODUCED '+5T-am ATr
OF021924A
J
n �Nce 1970 v �# EE021924
AS IC N.EEVIt05 8/30/2014
(seal)
SIGN*NTO
NO T . n 1 M ` TYPE OR P NAME OTARY
COMMISSIONNUMBER (��b({o�l/..DWI ttt`�I/U.,jUL
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
02/01/2012 15:10
772466='7�
SEACOAST AC
j
PAGE 02
CDUIVTY `
F L O P. I D FI
Fee
V
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 3491i2
M2)462-1553
SPECIALTY PERMIT APPLICATION
13 Electrical ❑ Plumbing 17 HVAC
❑ Shed ❑ Demolition ❑ Gas
Seepage 2 for hutruefions and additional paperwork
1. LocationtSite
2. ParcelIDNumber:
3
13 Fence
❑ Siding
permits
�bx
Tawsuldp
Range
Map Pare
2 ning Lord Use
IpKah
o,#Ice Use
Section
4. Owners Information 5. Contractors Information
Name: C FL Reg/Cert #: (( 9 ^`
Address: County Ceti#:
City: �j �� State: Busine Name.- ,
Zip: • 'C �Pjh�on,,e: I(J� 1 �`E`m 'phon Ls 'Foy
6. Value of Construction: $ ✓� J
) NERB AFTWAvrr: I certify that all of the information Contained ' s application is
A _ _ mf 1 prnpliaaa with all applicable laws reguiatir& c4nStrUC60n and 2.
c
`
AC14f10WLEDOED BEFORE ME THIS +RACY LANGF_L
/ DAY ,20 Y SY PUBLIC_wH01S PERSONALLY IINOWN T01.�_ `—OR WHO HAS PRODUCED , `a F' JTCv7;7CF'FLOrTIOA
As NTIFICA N ^c �I tmc-'e
� '". as 021924
IL` a W20'14
f
SIGNATUR FNO �, �p�v_�� J( TYPE ORPRIONAMEOENOTARY ( )
CONMISSIONNUMMER L.Ci( �" aCl V
NOTICETOOWNER; FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOIJR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT wrm YOUR
LENDER OR AN ATTORNEY 1IEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C.HEAT REPLACEMENT WITH CONTRACT UNDER S75M.00
Revhed 0412612010