HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONFee Due: g-
Permit #
Planning & Development Services SCANNED
Building & Code Regulations Division BY
2300 Virginia Ave. St. Lucie County
Fort Pierce, FL 34982 j/
(772)462-1553
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing ❑ HVAC
Shed ❑ Demolition ❑ Gas
Seepage 2 for instructions
1. Location/Site Address:
paperwork
2. Parcel ID Number: LII % — M A r MLJ o
❑ Fence
❑ Siding
5utredfor specialty
e
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
LA,
Vy-
3. Complete Description of Projector Work:
4. Owners Information ' �,/�v 5. Contractors Information
Name: (�i 6�1/� FL Reg/Cert #: 1 "'30 1 2-939
'.711,5F9
Address: County Cert#:
e S f
City: ff. State: _ Business Na e:
Zip: 3g9�1 Phone: l PhoneJ\ C Fax:
6. Value of Construction: $
OWNERS AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
_ - c p 'ance �with applicable laws regulatin construct'on oning.
PORT 0-01M R UU N ..: -.CTOR NAME :41GtATUFt Of ER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF I LW 1).,F A r I % In Y
nn���j� (�J' I 4
ACKNOWLEDGED BEFORE ME THIS DAY OF Math �--F—, 20 �i , BY
WHO IS PERSONALLY KNOWN 0 ME R WHO HAS PRODUCED `� _
IAS DENPIFICATION. 4 / T � t x %I
I.
NOTARY
NUMBER
NAME OF NOTARY
JACQUELINE DEGRANDIS
MVESMMISSION 0 EE204141
EXPIRES July 14, 20le
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 04/26/2010