HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDec. 05: 2013 16:21 HP FaAF Delta '8662190880 page • 11 ` t '
Date: Fee Dste: ;.
t., R 6
' St:"'Lucee"°County`Boildi>hg
._ 0Q0 vh&ia Avenub .Ft; Pierce, Fi 34982.5632 .1
. `�' I "' •� .. ° _ � , ++ .. Tel �S6t-46�•f533 � ;,i � ,. i � . ,: � . , ' II , I
SPECIAL'Z'Y-PERmrr "APPLI C TION:
. , ,, �. �. ' : " .: a ...: .. • .. ... , �` ��c/ GAY . �c0 I
Elec#rial Plumbin e
g '• C7''HVAC D Fenee'-04
C1' Shed Q Demolition` Gas '
�y.
CIr .S dmg
See page 2 for instreectPol7s qnd additional"
shied alty Pe
{ ,, paperryorkrequiredfor i r►atts:
' 1. locatIon/Site Address: '. '4
V } Yam"
:;2, Parcel ID Number: ' 143:1- ?•d 1' - 017.7'-:,'60o='
tl
5eed6n towns ](tau 11,1a Pa e • -061 ,•_ I:and'.itse �• ' IaitLiLs �` .
i• , , •`, . ' 1 1.' I i' f is
' 3. 'Description of Project or Work Activity: 11 W �p r . �.-1• ; ``: U " ,j '
7' ;.
a
4. Ownerg Information 5. Contractors Information
Name.-::. . i
Addressi ' g �' W i e— a. � County " Cert#: �„ •
hfne. t = ?hone! �p''Fau: ORA- a,
6. Value'of Construct on: g �
o►vxint+sAFFIbAV1T r . r cacti f?y that all ofthe moctnadon +coat ed 1h this lic ion.is'co�recf and'that'aU wo
in oornptianrp'widi all applioabte n rk nfi be done
%lativa$ �n f aad
PRINT QUALIFiWiS/OWNERS`NAME ° 3IGNA7UREOFQU OWNER' s
STATE OF FLORIDA, COUNTY OF i ! hoy-I ' r.l . ACKNOWLEDGED ME TFQg w� . DAYOF
20•};� BY ice, :.�801)C41/ WHO I3 PERSONALLY:KNOWN TO ME OP. WHO HAS:PRODUCED • : , "
AS IDE" WICATION.
a,h 15 'kt. ;n cx iUNQER
SIGNATLME OF NOTARY ';,.:TYPE OR PRINT NAME OF NOTARY ° ... * P!iVCO Q 1
62&$, ,
+ t f TI71:E: lVOTARY•r rwT.ir.'! COMMISSiONNUMBeR Iia a'. "i�T��fl' E8o ad�S;'FeErWty14 2018
Th"' B�f IlCtby tgWces
St Luck Coutrty Spcciahy Permit Appiicatioh re►. &'35.+b5 drrt�
.I