HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONFI7/1 R/7FI1 4 14. MR 91;1 —49 �77R1 ECM PAGE 02
Planning & .Development Services
Suilcling & Code Regulaltions Division Sc,�
COUNTY2300 Virginia Ave.
Fort Pierce, FL, 34982 St �G e y
(772)462-1553 C/@
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing L3 HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instrucaonc and addidonal,pupel°work required for specialty,perinift
1, LocatioA/Site Address: Jo�. lLrof k-e- l'..Ii
2. Parcel ID Number, � ",� �� t -p
QfpiCefise
Only
Section
Townihlp
RROKC
Map Pape
Zoning
Lnnd Uxe
lulrinls
3. Complete Description of Project or Work:. _ � • �j�-1 A) tY�'� � '�� (� ��
4. Owners information 5. Contractors Information
Name: ( L FL Reg/Cert#:
Address: �Cii Coulnty Cert#:�1—
City: (_,j.k-uosute: Business Name: TL"& 00 kAl>-0 Y1I
Zip: Phoney Phone: FIIx:
6. Value of Construction: S
OWNER'S AFFIDAVIT: i certify that all of the information contained in is application is corn et and that all work will be done in
compliance with all applicable laves regulatin onstmctio l i z
PRINT OWNER OR C5�CrOR NAME 51 t..U�t? Of'OWNLR OR 'RACTOR
STATE OF FLORIDA, COUNTY OF 1M +'tea'" 1
ACKNOWLEDGED BEFORE MF. THIS J— DAY OF, ��� _, 20 �, BY
���'
_
WtIO.1S rrRSc7NnLLY tCNL WN Tt) ME OR WHO HAS PRcrovCED
A$ t NTICICA7](,1L[ ..
giGAIA )REOFNOTARY�
wor ` CHUCK
arA peratrC
TYPO OR PRINT NAME OF NOTARY 1g1�1c 17:2 ,92
COMMISSION NUMBER
NOTICr:. TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND TO OBTAIN FINANCING, CONSULT "lilt YOUR
LENDER OR AN ATTORNEY BEVORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C,HEAT REPLACEMENT WrrH CONTRACT UNDER $7500.00
Rtwiaed 04/26/2010