HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION02/14/2014 15:54 561-4932701 PAGE 03
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Planning & Development Services
Building & Cade Regulations Division
M 2300 Virginto Ave. S
• Fort fierce, FL 34982 C'gN/j/Ed
(772)462-1553 st <GCj'9
SPECIALTY PERMIT APPLICATION unjv
U Electrical ❑ Plumbing 0 HVAC ❑ Fence
13 Shed ❑ Demolition 0 Gas ❑ Siding
Seepage 2 fnr %ntrue ons and additional paperwork requil°ed fnr specialty permits
1. Location/Site Address: Ssaq OV\p1(Aet
2. Parcel ID Nrunber: 3 5'QQ QQ�P .030 -(-k
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office Use
Only
3. Complete Description of Project or Work:
r,ird
4. Owners Information $.-Contractors Information
Name:
�� t FL Reg/Cert #:
Andress: '�� C-� County Cert#:
City: tlJiCr(7—State: � -- Business Name:
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Zip: :Plione- {- Dl -2Z �L . Phone:: 31Fax: ya-OA~1p�-
6. Value of Construction: $ CO, flQ - _--
OWNER'S AFFIDAvrr: 1 certify that all of the information contained in 1is application LH corr ct and that all work will be
compliance with all applicable laws regulati agtonstructioil z
_�.(C /
PRINT QWNL1t pR [:O R R NAME Q� St fUFi - Or OWNER R RACTOR
STATr OFFLOrtIDA, COUNTY OF Y� '•-�''" ' t}
AC•]{NUWLEfJG1713E1'()RE METHS ��- DAY OF_.ZO, By
.�.>.0
WII0 LS PERSONALLY KNOWN TO ME I/ OR w[40 HAS PRODUCED —
bENTIF[CATION. GILLIAN CHUCK
NOTARY PUBLIC
pLC►RIt1A (Rrs[)
SIG ATURE OF NOTARY TYPE OR PRINT NAME R. E�17x1$2
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COMMISSION NUMBER -
NOTICE TO OWNER: FAILURE, TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IM1FROY'CMENTS TO YOUR PROPERTY. IF YOU INTgNp TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORL RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -NEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010