HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: Fee Due.• Receipt# -I Permit #
y St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
T Tel. 561-462-1553
��ORt P
SPECIALTY PERMIT APPLICATION
scBNNF®
(Electrical ❑ Plumbing ElHVAC ❑ Fence St. kUCie you
❑ Shed ❑ Demolition El Gas ❑ Siding nfy
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: / 3 S d2 7 S L7 1 o, /li✓e - /0-� J!t 4 o_
2. Parcel ID Number: L%� G GI — So G l/ G� u O v _ 3
Office Use
Only
Section
Townshi
Range'
Map Page
Zoning
Land Use
Initials
Ilam/(,WEW
3. Description of Project or Work Activity: :T14.; a
4. Owners Information
Name:
Address: 3 10 1 • `?oh •. G l .e nN /9/Z'
City: -5 Ac h rclA State: !" -T
Ts— ti/"C
5. Contractors Information
FL Reg/Cert #:
County Cert#:
Business Name: �—C%JQJ1 ` e-c'�'r t Q-, ir,
Zip: aIlq �9 0 / Phone: Phone 3-7 0a4-:59 Fax
C-,_, S�/7 oZCoiZ-/7U0
6. Value of Construction: $ (o GU
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 regulating construction and zoning.
OF
STATE OF FLORIDA, COUNTY OF n—\ 0. - -tr 1 ACKNOWLEDGED BEFORE ME THIS / DAY OF
20-d BY -Tb \N tJ1� _OIU—) WHO IS PERSONALLY KNOWN TOME OR WHO HA UC$)%THRYN BUMBERA
.� �• �; t Et.1�L AS IDENTIFICATION. NOTARY PUBLIC
- r J n ` STATE OF FLORIDA
4W2
6RE
- -- ----- -$,c-m so as ^) !.� c s �n K) e� s�c� .CW# DD967559
F NOTARY TYPE OR PRINT NAME OF NOTARY Expires 3/3/2014
TITLE: NOTARY PUBLIC
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
COMMISSION NUMBER ( r� �J