HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONmate: 13� tA Fee Due: 10�� 1 Receipt# - 0 rmit # I'�0 j O 13�
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. S
Fort Pierce, FL 34982 C'q/�/��
(772)462-1553
C 4% Coc
SPECIALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty pennits
1. Location/Site Address:
2. Parcel ID Number: 34L4-al-1701-0001?
office Use
Section
Township
Range
Map Page
Zoning
an Use
lnitiaLs
Only
3. Complete Description' of Project orworkactivity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 8000 5 US # I
City: PSL State: FL
Zip: 34952 Phone: 878-5513
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
6. Value of Construction: $ 1e5,,0e. ?S O
---------------- ----- — ------------------
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application iscorrectand that all work will be done in
compliance. with all applicable laws regulating a nstruction a :Gnin
James W. Law
PRINT OWNER OR CONTRACTOR NAME S NATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 13 DAY OF 20 r BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JUUET LAW
NOTARY PUBLIC
AS I ENTIFI STATE OF FLORIDA
Juliet Law (Seal) Comm# EES46906
SIGNAWJRE OF NOTARY TYPE OR PRINT NAME OF NOTARY NOTARY
1042812016
COMMISSION NUMBER EE 846906
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: AIC-HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010