HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONFee Due: `r% -7� l Z9 Receipt# #
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
0 Tel. 462-1553
SPECIALTY PERMIT APPLICATION
❑
Electrical
❑ Plumbing
❑ HVAC
Q Fence
❑
Shed
❑ Demolition
❑ Gas
❑ Siding
SCANNED
BY
'St. Lucie Counit
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number:
Office Use
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I Map Page
I Zoning
Land Use
Initials
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3. Description of Project or Work Activity: {O l�rtuar V -(e?hP? (w) age Lr
4. Owners Information / D
Name: (7%Pen-u !�% ast�r��drs�i
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Address: (/ �(— c�0. JCYv ewy
City: P—P State: Y
5. Contractors Information
FL Reg/Cert #: _ (Y f t)l JI;7 ,
County Cert#:
Business Name:
Zip: 3t/9S/ Phone: 77a-q) JSO' Phone 77JJdOI3dS6Fax
6. Value of Construction: S Q^/G
OVVIAERIS AFFIDAVIT: I certify that all ofthe information contained in this application is correct and that all work will be done
in compliance with all applicable laws regulating construction and zoning.
PRINT QUALIFIERS/OWNERS NAME
SIGNATURE OF QUALIFIERIOWNER
STATE OF FLORIDA, COUNTY OF 1-:ht` -, {.,tA�it /y4, ACKNOWLEDGED BEFORE ME THIS �7 DAY OF
(YI• ilpCC—By -r%' ('may/ F-CTq' /4t=WHO IS�R3'ON)AZI.Y KNOW N TO ME OR WHO HAS PRODUCED �`��t��
IDENTIFICATION. 4�� d-�C� ���' ��� V,
}�D,�u/ �• �l�e ins ��
SIG RE F NOTA Y T}PC- OR PRINT NAME F NOTAR}'
TITLE: NOT RY PUBLIC COMMISSION NUMBER
RME
UMPHREYN#DD190387St. Lucie Count Specialty Permit Application rev. 8/25105 dmg rch6,20D7WricUrpemm'lers
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 55,000.
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or.blue ink
only) or typed. This permit application is to be used only for those activities that are not otherwise included
under a primarybuilding permit. This application may not be used for any activity that includes structural
alteration. The information to be provided with this application includes:
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
6. Value of Construction -
Indicate the street address or general location of the
property where the building activity is taking place.
Indicate the tax identification number of the property
where the building activity is taking place.
Fully describe the activity to take place.
Indicate the name and address of the owner of the property
on which activity is taking place.
Indicate the State of Florida registration number (if
applicable), St. Lucie County contractor license number
and the name of the business doing the work.
Indicate the total value of the work to take place. Total cost
of construction includes all current retail material and labor
costs associated with the building/construction activity.
Construction value is used to determine the permit fee. St.
Lucie County reserves the right to question and/or modify
the indicated value of construction if it is demonstrated that
the submitted figures are not consistent with similar types
of construction.
❑ Gas
Attach 2 piping schematics with tank size, location, and BTU of each appliance
❑ Shed:
Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications
❑ Fence
Attach 2 plot plans showing location of fence height of fence and type of fence
❑ Siding
Attach 2 copies of manufactures specifications
❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement
This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort
Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications
will be accepted for processing after 4:30 P.M. For assistance in completing this�application, please call
(772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
NOTE: Emergence electric service change out inspections will not be performed after 3:00 PM without
special arrangements and additional fee paid.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261
St. Lucie County Specialty Permit Application rev. 8/25/05 drug