HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONSt. Lucie County Building & Zoning
C) 2300 Virginia Avenue Ft. Pierce, FL 34982-5652
COI; Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
SCANNED
El Electrical El Plumbing AC El Fence
❑ Shed El Demolition 9Gas
❑ Sidingst. Lucie County
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 31 W 0& 1 A# 1 k V
2. Parcel ID Number: N'36-bw - C050 —XO'3
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Office Use
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T=Pip
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I M5ptgagej
Zoning
Land Use
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3. Description of Project or Work Activity: ou- cix- I I cif -I
4. Owners Information
Name: F Ql n i. QAI son
Address: 31co N t&pc l-In
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City: � t � State r lam
Zip: 3`t"1 IC( jPh�one: �y�
6. Value of Construction: $ '�I � - W
5. Contractors Information
FL Reg/Cert #: CACz I e))6-q g (Q
County Cert#: 0-q 16( J
Business Name:µ� ( r / ?r�<.w
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Phone Lfb`1-n�Fax CRi'b- O a Ct
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done
in compliance with all applicable laws regulating co�st�a ctiorrand-z6nft,
OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF J 7 u G� ACKNOWLEDGED BEFORE ME THIS _Ua.DAY OF
.20QF+BY Oij ��/�I�FF/Ztl(�WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
,ASS IDENTIFICATION.
C A Hamann nn Q"71'1 NOTARY IIUBLIC-ST� f F FLORIDA
SIGNATURE OF NOTARY'TY E R PRINTNAME F 1 OTARY Mary Ann Fungone
n : NOTARY PUBLIC COMMISSION NUMBER it s, CO111ID1SSIon # DD448431
Expires: AUG. 22, 2009
Bonded Tluu Atlantic Bonding Co., Inc.
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg