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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate � IFee Due' Receipt# > Permit # io Planning & Development Services Building & Code Regulations Division 7300 Vhtnia Ave. Fort Pierce, FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 jor lnstrucdons and additional paperwork required for specialty permits 1. Location/Site 2. Parcel ID Number: 3. GO NN L 4. Owne Inform' saLLO lt` 5. Contractors Information Name: CAI t+1�i't „(�L '�Cl_ FL Reg/Cert #: CG Cp© rfrf6 Address: i3J Qom( WA L1�12, _ Co�tyCert#: �� CS� City: C11 State:��GBusinescs Name: Zip: `1�� Phone J—�lione LfFai:��� 6. Value of Construction: S q f a3'' correct with all applicable laws STATE OF FLORIDA. COUNTY ACKNOWLEDGED BEFORE ME THIS) © DAY OF W�.20�11 BY WHO IS PERSONALLY KNOWN TOIM ---'OR WHO HAS PRODUCED TRACY LANGEL NOTARY PUBLIC STA`IFLORIDA TYPE ORP N FNO AR a uomm#EE021924 4ic :e�� Expires8/30/2014 NOTICE 700WNER FAILURE TO RECORD A NOTICE OF COMMENC&�IVT MAY RESULT IN YOUR PAYING TWICE FOR MffROVLNU3'IS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR EXEND?T. A/ IDREAT REFLACEBIENr WrM CONTRACT UNDER SS,DOO. OF COMMENCEMENT. 06/10/2011 09:14 7724667 -_ SEACOAST AC i PAGE 02 Date: I Fee Due: R Permit # I l Ou - 0 f Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34992 (772)962-150 SPECIALTY PERMIT APPLICATION 0 Electrical 0 Plumbing l] Shed ❑ Demolition Et HVAC ❑ Fence ❑ Gas ❑ Siding SeepWa2 for brsm+dWin and adddlmmf paperwork required jor spetid&y prrm & 1. �eeatda��te�►adrr�:3 tZ ra.A'1 A-3 2. hired IDNamber: ra 7,1g,WDa — Townsmi % Mxprxu zn6 I Land use Id Mh Office Use O* Seetlon as �� r�a� 12�tD 3. Complete Description of Fnmect or Work: 4. own Infdrma ' ` 5. Contractors Iniermation Name: { ka �L i FL ReWCert 0. 0 i i_fe5Z4 Address: D -% QTP� Ce®tyCan & CZ� City: C r state: �L^k� _ 1�L [� Business Name: Zip: now ���1� "7✓ one: o Fa::��l 3c1s3 6. value of ConsbMetion:5 OWNER's AFFIAAVr[: I cRUfy that aU of we mto =uon CEDiamea Ms appucaaon �vucct auu usu as w�+a w ,, compliance with all applicable laws regoh% stinction as oning. I'MMOWNF.R OR CONTRACT NNG-Ab1E- -- - - - OF Owl O OR STATBOFFLORIDA. COUNTY OIC,'-V 1\. AMUWLWM BEE<= WE TWS) © DAY OF�/�j �20 �11 aY Jahn N - LMo -e. WHO13 FOWNALLY SNOWN TO NE I�-'OR WRO HAS PRODUCED TRACY LANG(1 i' NA : FN '� �� � NOTAFiYPUBLIC TYPB OR ETA FLORIDA C:anm# EE021924 e�° Explressl3onot4 NOTICETOOWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYWG TWICE FOR IMPROVEPIVITS TO YOUR PROL')ZR'lY. IF YOU MOM TO OHTAM FrUNC1N% CONSULT VTM YOUR LENDER OR AN ATTORNEY BEFORE AECORDING YOUR NOgrCE OF COMMENCEMENT r:XF.MPI% AWMFFMAT RRPLACE11W IT WITH CONTRACT UNDER SSM&