HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Du,.� I Receipt# Permit #
` -1 1�� NO( -(MZ
_ Planning & Development Selwices
5 J t Building & Code Regulations Division
2300 Virginia Ave. S
- Fort Pierce, FL 34982 Clq, /V�
(772)462-1553 S't eY
PERMIT APPL u�l� county
SPECIALTYICAT j
❑ Electrical ❑ Plumbing ❑ HVAC Fence hf �f� f '.0•
41
El Shed ❑ Demolition ❑ Gas ❑ iding4,0r
See page 2 for instructions and additional paperwork required for specialty permits '�V11 C
1. Location/Site Address: OIA e? o 7 i
/� L
2. Parcel ID Number: I +� U lc, �aJ t, J o os l n crc)
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Descri/ntinn of Prniect or Work: Oeict 10e Act3 1/�� ,
-L �Jeld OL-6
4d3L'l �Lt� ��r � �., �� a!� k � rt�►1\ �' S � v / d
4. Owner& ;nformation - / 5. Contractors Information
Name: V� J' n i )-e5 �m AP h ✓OIvL
Address: �( 4 �e-6 r R -Qi( r
City ��r�p�� State: (�
Zip: V Phone:
6. Value of Construction: S -7,.
FL Reg/Cent #:
County Cert#:
738
CC I.5-9 Z7
Business Name: k � btl;oe #j- 4fH'P✓
Phone: 471 C ( R? Fax: 96 4 WO
OWNERS 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 zoning.
STATE OF FLORIDA, COUNTY OF.
ACKNOWLEDGED BEFORE ME THIS DAY OF
WHO IS PERSONALLY KNOWN TOME OR WHO H S PRODUCED
OF OWNER OR CONTRACTOR
20 fv.BY CND
MENTIFICATION.
DAWN WIA r
_ I / .,,.....,
��.4Pavv�a,, WI
° Notary Pf iNk • State of Florida
SIGNATURE OF NOTARY T OR PRINT NAME OF NOTARY '. ' "� • "e My Comm. Expiros filar 22, 2017
Commission # ES 077571
COMMISSION NUMBER �'' ° ii ��'�, Bonded Through Natlonal Notary Am.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR TA NG' YM F
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 04/2612010
A BOUNDARY AND RECORD SURVEY FOR RICHARD NEXAND
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