HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: 113l Fee Due: I a c d Receipt# W1 It s ermit # 101 0134
. Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. SC
Fort Pierce, FL 34982
(772)462-1553e���0
SPECIALTY PERMIT APPLICATION cool
® Electrical ❑ Plumbing ❑ E VAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and addildon_�a-� ll %paperwork required for specialty perinits
1. Location/Site Address:
2. Parcel ID Number:
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Project or work Activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: WVnne Bldg. Corp
Address: 8000 S US # I
City: PSL State: FL
zip: 34952 Phone: 878-5513
6. Value of Construction: $ 1o20f%�� d
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'sAFFIDAVIT: I certify that all of the information contained in this application is correct and that all will be done in
compliance. with all applicable laws regulating c ruction and zonin
James W_ Law
PRINT OWNER OR CONTRACTOR NAME Z IGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 13 DAY OF 20 BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JULIET LAW
. NOTARY PUBLIC
AS [PEN STATE OF FLORIDA
Juliet Law (Seal) CoFnm# EE846906
SIGNA RE OF NOTARY TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER EE 846906 Fires 10/2a/2o16
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 S7500.00
Revised 04/26/2010