HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate n Fee Due r t� Receipt# � � Permit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982 ®�CAN�ED
(772)462-1553 8Y
Lucie Got'
nty
SPECIALTY PERMIT APPLICATION$.
❑ Electrical ❑ Plumbing
❑ Shed ❑ Demolition
Seepage 2for instiuctions and addict
1. Location/Site Address: t JA co
2. Parcel ID Number: i�-A -- k Uk W
3.
4.
❑ IiVAC ❑ Fence
❑ Gas ❑ Siding
required for specialty permits
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Section
Owners Informatioq 5. Contractors Information
Name:S//Q�IJ�i1//1��11nnJl��syl���
Address:
City: P iC State:
Zip: Phone:
6. Value of Construction: S J1 19
OWNER'S AFFIDAVIT:
STATE OF FLORIDA. COUNTY
ACKNOWLEDGED BEFORE ME THIS
FLReg/Cert#: CaG��99D i�4��6
County Cert#:
Business Name: SPA CDR S!G
Phone: �6E- foa Fax: `f6� 3853
all applicable laws regulating
DAY OF ui1P .20 II BY
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WHOIS PERSONO ORWRO HAS PRODUCED
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aQCATION. 3 y1
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SIGNATURE OF ARY�TYPE OR NAMED OTARY tom-nv�y
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COMMISSION NUMBER o a p n r
NOTICE TO OWNER FAILURE TO RECORD A NOTICE OF COMMMCEMENT MAY RESULT IN Yo& F#mG TWICE FOR
EnPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: AIC•HEAT REPLACEMENT WITH CONTRACT UNDER S5,000.
06/24/2011 14:05 7724663E �SEACOAST AC PAGE 02
MGM
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, M 34992
(772),10-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical 13 Plumbing . a HVAC ❑ Fence
0 Shed 0 Demolition 1J Gas ❑ Siding
Seepage 2jnr b/�u�ydru�c Mn and adA *nat pgai/orrk�r\v&ed jor speelal+ti' pawn&
1. LoaMoa/Slte Address: l tiJ
2. Parcel ID Number:
3.
4.
QWners lB[ormatio 5. Contractors Wormation
Name:
Address:
city 0�2'0 C sate..�L—
Zlp: 34qqq. Phone:
6. Value of Caosbiwdon: S a I
FL Reg/Ceri #:
4aG0 l !P'i<f"
County Cert#:
Business Name: <— .
Phone: it f-J0 Fa:I: �6� 3as3
AFb7AAVrh ACetArytaalauarmel��m.uuuu ....�...w rr - __..
compliance with all applicable laws re8niatin8 coon and
STATE OF FLOMDA,
ACPMWLBBOED BEFORE METRES "-1 DAY OF lJH1 1e �r �
WROISPM0NALLYKNOWNTO9 ORWHO HAS pROWCEO `�
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CATION. 1 N r
sR9NAIVRBOF ABY,,cc-� 11 - � TYPBOR NAMEO ARY
LC. l�la 5 m
GVMM6SIODTDRIMBER m reOa � O r
NOTICE TO OWNER FAILURE TO RECORD A NOTICE OF COM MMLSIENT MAY RESULT IN YOWOPAhNG TWICE FOR
EIIPROVEM M" To YOUR FROPERTX. Ep YOU INTEND To OBTAIN PIKANCIMCG CONSUT WIIR YOUR
IMWr,R OR AN ATTOMWY BEFORE; RECOBUING YOURNOi10E OFCOM:@iCEMENT.
EREMPT: AIC-BEAT REPLACEf11EW VMM CONTRACT UNDER SS.ese.