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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: ❑ Electrical ❑ Shed Fee Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Permit # SCE St 4u &)' pie CoUnty SPECIALTY PERMIT APPLICATION 2/plumbing ❑ HVAC ❑ Fence ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork requiredfor specialty permits 1. Location/Site Address: i a % 3Y�Oh �i�.e /jl(/d• 2. Parcel ID Number: 1414 7�0 — (000 1000 - % Township Range Map Page Zoning d Use Initials Office Use Section Only 3. Complete Degcription of Project or Work: a/A-Tl�- 4. Owners Information ) 5. Contractors Information Name: /�� �,E�o / / al %') PAO FL Reg/Cert #: Address: City: GS State: Zip: '�7� _ �1-9Y�� Phone: J7 G 6. Value of Construction: $ �© OWNER'S AFFIDAVIT: I certify that all of the ar=c i'��56&1�7 Business Name: G_�t� (/mil /"Lf/W V / f2 Phone: ©� "'"Fax:-77 �-Ojv3�v7✓ STATE OF FLORIDA, COUNTY OF /r ( L//-K '^ C l.WV M 4 / / ACKNOWLEDGED BEFORE/MBE. THIS DAY OF �" I- w 204, BY MAM r 6.6 Y04 WH S PERSONALLY KN9(A TO ME OR WHO HAS PRODUCED 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