HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONMar 07 2014 12:28 HP FaxF1 Delta 8662190880
page 1
Date:
Fee Due:
Permit #
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel, 561-462.1553
SPECIALTY PERMIT APPLICATION
❑ Electrical '*Plumbing ❑ HVAC ❑ Fence SCAN Q)
By
❑ Shed ❑ Demolition ❑ Gas ❑ Siding �r QiCie County
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: 7()' - ow ,
3. Description of Projector Work Activity:
4. Owners Information
Name:
Address:�j3
City: 1 'State: —
5. Contractors Information� /
FL Reg/Cert #:
County Cert#:
Business Name:
Zip: �-b Phone: L- tO-
6. Value of Construction: $ r1gQ
OFt `ER'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 QUALIFIERSJOWNERS NAME SIGN A F QU E WNER
1 1 �J_U�}
j%STATE OF FLM-DA, COUNTY OF J ME THIS , DAY OF
vc 20 • $Y ti m 1 Y L� i Jf3i��ajVHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
�y f/ AS IDENTIFICATION. u
1 vi GL 'e—r (seat)
V JIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY j? 'BLIC COMMISSION N;JMBER
JAMS A. KINDER
$ , � � I,fY COMMISSION ti EE 16284a
EXPIRES: February 14, 2016
St Lucie County Specialty pit Application rev. &'25105 dmg ern B ododrhmDudgetNA.wryServkas
TRANSMISSION VERIFICATION REPORT
TIME 03/25/2002 23:56
NAME
FAX
TEL
SER.# BROF3V449734
DATEJIME
03/25 23:55
FAX NO./NAME
918662190729
DURATION
00:01:02
PAGE(S)
03
RESULT
OK
MODE
STANDARD
ECM