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HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due: ' Recei -w Permit - Off-' Planning & Development'Services P . - Building & Code Regulations Division Q CiU�S 2300'Virginia Ave. r . Fort Pierce' FL 34982 " (772)462-1553: ` 1� ` �• SPECIALTY PERMIT. APPLICATI ❑. Electrical .Plumbing ❑-HVAC ❑ Fence 8C ❑ -Shed ❑Demolition ❑ .Gas ❑.:Siding: Seepage 2 for instructions and additional paperwork required for -specialty permits . C'0 Uq�y 1: Location/Site. Address:..) Z 316 .N w f 4A aAoOiz r � cio ►9 1 �1. 3 p 2. Parcel lDNumber: . 4 26- Cv019 - MO©5 3. Complete Description of Project or Work: Ai' �Fikc u ln( MASS a A�aT�lci l� G va �ufl L OCwT10%. or (!av o Tfa CLOSE_ r *r GAM-tDMIMC510u, Oa TEA -6 SmWE2ANR.w WIG I'LAt orb 4 / KITCweN ` �Pc+'►CErv�„� �� SIwK 4. Owners Information -: 5. Contractors Information, -Name: No E� nE ��. �u FL Reg/Cert #: CF-C14 Z7 97e'r Address:. 123►19 Ww 1-1A260,,e_ R'je-Bw,� County Cert# ZSB.b$ City: 'per wh CI Tu State: FLo� l n w Business Name: .� �P. lt'o N N E l�i.vn l31 nib r . �e Zip: 3-4 99 Phone: Phone:('mi. ZI T • 4404 - Fax:���� 6. Value of Construction: $ Z 1sco •�0 OWNER'S AFFIDAVIT: I certify that all ofthe information contained in this application is correct t woik will be donein- -- compliance with all applicable laws regulating constru 'nand zorii �. R U�ONca•�,�. - PRINT OWNER OR CONTRACTOR NAME SIGNAT OF O ER OR:CONTRACTOR STATE OF FLORIDA, COUNTY OF a V 111 KIMBERLY A. WALKER . eotARYgsso� NOTARY PUBLIC ACKNOWLEDGED BEFORE -ME THIS I DAY OF W 1 20 ; BY-J•a' �O'uNEL o c E OF FLORIDA . WHO IS'PERSONALLY KNOWN TO � OR WHO HAS PRODUCED ". ? Comm# EE134449 c¢.�e • . Expires-3/1812014 AS IDENTIFICATIO SIGNATUR OF NOTARY T E OR P T.NAME OF N T RY 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 Township Range Map Page Zoning, La Use Initials - Office Use Section. On1Y: 1