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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION0, Date: Fee Due:` AT ,l_ectrical ❑ Shed Receipt# Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Permit # / a• ©� Seq "Cie CQ�a/�t f SPECIALTY PERMIT APPLICATION —0-Plumbing _ ❑-H_V_AC ❑ Fence- ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for i(nst�rucdons and nadditional paperwork required for specialty permits 1. Location/SiteAddress: JqV .) �ffl `C`Q,���j� '`P�(���, 2. Parcel ID Number: " �111 - L� 0q %A - M& 0 Office Use Section Township Range Map Page Zoning Land Use Initials Only 3. Complete Description Cro! eiA,l n e—e_A F PL- 4. Owners Name: Address: City: Zip: or Work: C 71— 6. Value of Construction: $ Q . V 52iv,Le.. ed(anCe- 'vs-f- d- ijc,ee- ice. a1c-z� � C OWNER'S AFFIDAVIT: I certify that all of the information contained in this appl' ation is correct and that all work will be done in compliance with all applicable laws regulating cons io d zo ' g. PRINT OWNER OR CONTRACTOR NA SIGN OWN R OR CONTRACTOR STATE OF FLORIDA, COUNTY OF �� G' 1.Q ACKNOWLEDGED BEFORE ME THIS DAY OF Lim, 20—L, BY WHO I PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS 1 NTIFICATION. air p 8ot� �d!?lirk atefaida SIGN E OF NOT TYPE OR PRINT NAME OF NOT11 V l� IJWg(if71 Y OR1H7101P.41§ 99c�1 COMMISSION NUMBER °arPb E£>ryir�® Al71�9� 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