HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONI�
Date:
Due:
J
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
Permit #
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ® Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 15901 Orange Avenue
2. Parcel ID Number: 2212-421-0022-000-0
SAC
St 44 By l
%
Co4nty
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work:
Can off water in screen shelt _r room s .hPdlllPd to hp demolished
4. Owners Information 5. Contractors Information
Name: Craig Carter Denise Carter FLReg/Cert#:
Address: _15901 Orange Ave County Cert#:
City: Fort Pierce State: Florida Business Name:
Zip: 34945 Phone: LjC4 hone: 344-6789
6. Value of Construction: $ 1,000
CFC 032579
Fax: 344-6789
OWNER'S AFFIDAVIT: 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 regulatin construction and zoning<-;'1w2.
Jan c
PkINT OWNER OR CONTRACTOR NaME SIGNATUFt OF OWNER R NTRACTOR
STATE OF FLORIDA, COUNTY OF _ St LU Cle
ACKNOWLEDGED BEFORE ME THIS _ DAY OF 20 ! 3 • BY —LX &- Y1QVC4/1 14V PiI'1-
WHO IS PERSONALLY KNOWN TO ME �OR WHO HAS PRODUCED
AS IDENTIFIC TION. off"' °�a� Notary Public State of Florida
Nichole(j
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY 9�of c�oo-A� E y co commioviission
E5 054615
COMMISSION NUMBER
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
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