HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION_Z
Permit #
Date: Fee ]' Recei t#
Planning & Development. Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
lea -6 �oy
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:
2. Parcel ID Number: 1301-111-0001-000/5 -- -
Ofce Use
Only
Section
To,.vnship
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Projector Work Activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 12804 SW 122nd Avenue
City: Miami State: FL
Zip: 33186 Phone: 878-5513
6. Value of Construction: $- `a e;,D- 06
S. Contractors Information
FL Reg/Cert #: ER 0000122
County Cert #: 2098
Business Name: LaW'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 regulating construction and zo in
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 26 DAY OF 20 / 3 , BY James W. Law
WHO IS PERSONALLY KNOWN TOME X OR WHO HAS PRODUCED
AS I NTIFICATION. JULIET LAW
Juliet Law (Seal) NOTARY PUBLIC
S[GNA OF NOTARY TYPE OR PRINT NAME OF NOTARY
STATE OF FLORIDA
COMMISSION NUMBER EE 846906 Comm EE846906
*EX Ifes'10/28/2016
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO''6UR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YQUR LENDER OR AMATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010