HomeMy WebLinkAboutSUBMITTED PAPERSDate:
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Due: r�_ Receipt# Irmit #
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COUNTY
F L O R I D _A
MUNN- -i
Planning & Development Services SCAN1NED
Building & Code Regulations Division B
2300 Virginia Ave. Y
Fort Pierce, FL 34982 « coui1Cy
(772)462-1553
SPECIALTY PERMIT APPLICATION
AZ -
Electrical
❑ Plumbing
❑ HVAC
❑ Fence
❑ Shed
❑ Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additionalpaperwork req uirredfor specialty permits
1. Location/Site Address: Loco C)Cang,(Z- -A-Vc 2. Parcel ID Number:
Office Use
Only
Section
Township
Range
Range
Map Page
Zonin
L d Use
Init' s
3. Complete Description of Project or Work: Z�
4. Owner Information 5. Contractors Information
Name: FL Reg/Cert #:
Address: i County Cert#: 2-050 2
City: `Q State: Business Name: C i1 1
Zip: ( �hon lPle ' b{ ,-&.J`�= l �� 1 —T J
6. Value of Construction: $
OWNER'S 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.
PRINT OWNER OR CONTRA TIO t MEN ti SIGNAT OF OWNER OR CORTRACTDR.
STATE OF FLORIDA, COUNTY OF lr\-C\E!�
ACKNOWLEI)2gp VEER "" -THIS DAY OF -e�-20_y— 5
Y KNOWN TO ME ) OR WHO HAS
AS IDENTIFICATION. 01
916N'ATMI!0 ARY
COMMISSIONN ER
NOTICE TO OWNER: FAILURE TO RECORD A NO
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
j EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500.00
I
i
Revised 04/26/2010
JOSEPH E. SMITH, rMkKI*� ,411E CIRCIJ;C'I'-COURT _ SAINT 7UJ�28 COUNT'
FILE # 3903501 OR BCiCiK 35fi4 PAOEE 998, Recorded 12/04/2073 at 11::49 AM
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RECEIVEDE
£0'd 389b-T9b-3LL OlaIODTZ BTnasIl 11yet,".30 £T/T£/ZT