HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONFee Dc
Planning & Development Services
J ' _ = _ Building & Code Regulations Division
p 2300 Virginia Ave.
o111tillFort Pierce, FL 34982
(772)462-1553
Permit #
13P- �
SPECIALTY PERMIT APPLICATION
❑ Electrical t6lumbing ❑ HVAC ❑ Fence
❑ Shed ' ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for insirr�uctfio/ns and additional paperwork required for specialty permits
1. Location/Site Address: � 5 ✓ '" E Suynyner Pd
/,j
2. Parcel ID Number: '�J ✓ f q - 570 - QQ1'(�7 '-Q®o' Q O
Township
Range
Map Page
Zoning
Land Use
Initials
Office Use
Section
Only
3.
4. Owners Information 1 5. Contractors Information
Name: 3bjQ)OVI ,p "� S1)yo'
Address: 02 0 5 5 F 690 k 4�-e Si
City: l, SA lGe State: q
Zip: J ;1 q B Phone
6. Value of Construction: $ vl
FL Reg/Cert #: Cr-C 6E65 /
County Cert#: '27 3 7 2
Business Name:
Phone k J'1 5q-�5g0Fax: 671 - 95U 6
OWNER'S AFFIDAVIT: I certify that all of the information contained in 's application is correct and that all work will be done in
cam nyc�e with all applicable laws regulatiK-12
truction and ling.
PRINT OWNER OR CONTRACTOR NAM F OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF (J`
ACKNOWLEDGED BEFORE ME THIS DAY OF fwN 20BY
i
WHO IS PERSONALLY KNOWN TO ME_XOR WHO IIAS PRODUCED
AS IDENTIFICATION.
""' Radina Stoyanova
,rn�'•:
?:°'(�j�, �CjSION;#EE837091
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY ;y' ...F,-EXPIRES: SER 20, 2016
EE 837oq 1 '''°� COMMISSION NUMBER �.,,,,,� W1NW.AARONNOTARY.com
NOTICE TO OWNER FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TRICE 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