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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONI Date:, I rV— 12 I Fee Due:GS 7 /n 1 Receipt#Q^ l) q I Permit # I I Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 6b F3 SPECIALTY PERMIT APPLICATION 3v`;t -of oF ff Electrical ❑ Plumbing ❑ RVAC ❑ Fence SCANNED ❑ Shed ❑ Demolition ❑ Gas ❑ Siding BY St. Lucie County See page 2 for instructions and additional paperwork required for specialty permits 1. Location/SiteAddress: 4090 G AV 2. Parcel ID Number: 2S32 - Sb0- 00m - © 00' Ll 0)T Use Section Township Range Map Page Zoning Land Use Initials Only 3. Complete Description of Project or Work: lv 00 SIAI G 4. Owners Information 5. Contractors Information Name: LJt t-4% FbA FLReg/Cert#: STC 206 Address: 1N01MTaVN TLO CountyCert#: City: Zip: iPtxa. State: TL Business Name: 3N1%-5'1u3 Phone: 6. Value of Construction: $ Z J50.00 FL 1300t4a- 2G1&4 Gr- Phone:(121-C{9L1 Fax: -117-6ZI-a144 OWNER'S AFFIDAVIT: I Certify that all of the information CAntai ed i his al) i'on is correct and that all work compliance with all applicable laws regu in stnlc a I nd zoning. CKQ—Q .y2 &POMIJ-4 PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER CONTRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFOREMETHIS Z-5 DAYOF 20—Zg— BY (thalP4b4ww—�N._ WHO IS PERSONALLY KNOWN TO ME-4/ OR WHO HAS PRODUC D -� ASI NT ATION. , CHRISTINE CRAVEIR CI MY COMMISSION # EES59431 Dooamber 19.2016 (seal) siOSxtUREOFNOTAkT TY (AflMAME Jii v oaom COMMISSIONNUMBER dfC f" *31 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 S7500.00 Revised 04/262010