HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONAug 26 2000 09:45PM HP FaxMirandb Sales 772871 863 page 2
Date: Fee Due: Recei t#
Planning & Development Services
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Building & ode Regulations Division
2300 Virginia Ave.
_ Fort Pierce, FL 34982
-_ (772)462-1553
❑ Electrical �iPlumbing
❑ Shed ❑ Demolition
Seepage 2 for instructions and
1. Location/Site Address: '51 a 1 (�
2. Parcel ID Number:: -1) - ' '- I
1
Permit #
� SCg�NE�
Cie County
TY PERMIT APPLICATION
HVAC ❑ Fence
Gas ❑ Siding
al paperwork required for specialty permits
Office Use
Only
Sem'an
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: G C '! 1 L
4. Owners information
Name: A&Ir
Address: / ' I V
City: 'pi ( �. State:
Zip: b Phone: V'
6. Value of Construction: $ ; 62. ✓✓ v
5. Contractors Information
FL Reg/Cert #: 1 42 7
County Cert#: -/ I?a....... 000 NT-- 1 / 1 I' Y 17-/) dW k
OWNER'S AFFIDAVIT: I certify that all of the informal tan contallra
compliance with all applicable laws regulate
Jon d l
PRINT OWNER OR CONTRACTOR NAME SIGN
STATE OF FLORIDA, COUNTY OF r G
ACKNOWLEDGED BEFORE ME THIS 3 DAY OFJ
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
AS IDEAFIC&Q f A
SIGNATURE OF NOTARY
COMMISSION NUMBERy td 2 4
NOTICE TO OWNER: FAILURE TO RECORD A
IMPROVEMENTS TO YOL
LENDER OR AN ATTORNE
EXEMPT: A/C-HEATREPLACEMEN'
PhonedIN" d -5/2 Fax:Z1
all work will be done in
ction and zoning.
OF OWNER
20�3 ,BY
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P11 FEB, 09, 2017
TYPE OR PRINT NAME OF NOTARY pONNOTAAYcom
NOTICE OF CO-AIMENCENIENT MAY RESULT IN YOUR PAYING TWICE FOR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
WITH CONTRACT UNDER $7500.00
Revised 04r2612010