HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: J Fee Duey ! Recei t# Permit #
Planning & Development Services
Building & Code Regulations Division SCANNED
2300 Virginia Ave. ,, By
Fort Pierce, FL 34982 st k ucle CO
(772)462-1553 Un f y
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: Z
2. Parcel ID Number: 3414-501-1701-000/9 A�1
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
IN
Initials
.
3. Complete Description' of Projector Work Activity: Replace meter center, with a combo pack at each address
4. Owners Information
Name: Wvnne BldR. Cor
Address: 8000 S US # I
City: PSL State: FL
Zip: 34952 Phone: 878-5513
6. Value of Construction: $ d U D
5. Contractors Information
Fl. Reg/Cert # ER 0000122
County Cert # 2098
1
Business Name: Lav/s Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
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 o struction and zoning
James W. Law %2/ 4�G�
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS /? DAY OF 20 _/:?_ BY James W. Law
WHO IS PERSONALLY KNOWN TOME X OR WHO HAS PRODUCED JULIET LAW
TARP PUBLIC
9cm It—
AAENTIFICA O %iWSTATE OF FLORIDA DA
Juliet Law (Seal) Comm# EE846M
URE OF NOTARY TYPE OR PRINT NAME OF NOTARY EWrreS 10/2&2016
COMMISSION NUMBER EE 846906
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 S7500.00
Revised 04/26/2010