HomeMy WebLinkAboutSUBMITTED PAPERS❑ Electrical
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Plumbing
❑ Demolition
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See page 2 for instructions and additionalllpaperwor�kk required for speectaftty perinfts y
1. Location/Site Address: 110 �. , 5 I ": av— 4-, V< r 1d��v G ! +
2. Parcel IDNumber: 3S32 S�3' 6Z0
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: /n,,5 ki/ q l� L6"
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4. Owners Information 5. Contractors Information
Name: W : U 1 awk- &Iv1, S FL Iteg/Cert #: d6C o YK rO
Address: ( (p q 1 5 /w d, a yx�- t- �(aCr IJt r -e County Cert#:
City: i't`e rt State: '+i— Business Name: Ue-Ferku.s Fei e- I&YOCTIOV,
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Zip: �J l ��I Z Phone: Phone: 33�-,8 v9S Fax: off?
? -600
6. Value of Construction: $ b Z'do- o d
OWNERS AFFIDAvrr: 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 regulatipg�� and zoning.
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PRINT OWNER OR CONTRACTORNAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF - %L 1
ACKNOWLEDGED BEFORE ME THIS � DAY OF 20 Of BY
WHO IS PERSONALLY KNOWN TO ME k_ OR WHO HAS PRODUCED
AS IDE TI C:ikL
,.... ICIRKARIKATZ
4.e OMMMSION #'FF044924
`p� a, a� �,seal�''O N ARY OR PRINT NAME OF NOTARY E MRESAugust 12. 2017
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COMMISSION NUMBER { OP+
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 $7500.00
Revised 04/262010 (-S (—I
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