HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONP-1- - -•it #
Planning & Development Services
Building .& Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical
❑ Plumbing
�HVAC
❑ Fence
❑ Shed
❑ Demolition
❑ Gas
❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: 3-3-34 —
sCe yNFD
COur1f
Y
office Use
Only
Section
ToVMSlup
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project Qr Work:
4. Owners Information 5. Contractors Information
Name: 151 i 00-be-(n ,ar Cna r-)FL. Reg/Cert #:
Address:.
City: ` Pb(-4— t� a
State:
Zip: 3 4 i q( a Phone:
6. Value of Construction: $ 4 q a0.. O0
County Cert#:
Business Name:
Phone: -00 bq Fag:
OWNER'S AFFIDAVIT: I certify that all, of the information contained in this application is correct and that all work will
compliance with all applicable laws regulating co on `" `d zoning:
PRINT OWNER OR CO RACTO AhlE SIGNATURE OF OVER OR CONTP4CTOR
STATE OF FLORIDA, COUNTY OF e-�' LL4,p 112-
AC14NOWLEDGED BEFORE ME THIS AY OF 20) 4 , BY
WHO IS PERSONALLY KNOWN TO ME ZIRUWHO HAS PRODUCED
OS IDENTIFICATION.
'--� �f`� A I =oa� oG� IEp�ta( Public State of Florida
TYPE OR PRINT NAME OF NOTARY v [} ah Russell
SI ATURE OF NOTARY �9r�. �o My Commission EE038992
/n� ^/ EoF e�°V Expires 11 /05/2014
COMMISSION NUMBER �)�'-'1 LgQC
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 -SEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010