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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: Fee Due: '�'_..'' Recei t# Permit # '1q61 601© _ Planing & Development Services Jn 1= Building & Code Regulations Division i - 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence S ❑ Shed ❑ Demolition ❑ Gas ❑ Siding 8 F See page 2 for instructions and additional paperwork required for specialty permits 1 �Q& C O 1. Location/Site Address: ��y" is©l— p 2. Parcel ID Number: AN i Office Use Only Section Township Range Map Page Zoning Land Use � Initials 3. Complete Description of Project or Work: A� /d 4. Owners Information .fp 5. Contractors Information Name: l Address: %y� �/✓i f iS�i Q/r/fv / V City: State: Zip: `%�Jr-2 Phone: a7:rW 6. Value of Construction: $ 3 6 �1D /.? J-f FL Reg/Cert #: c 1R c D 541 i County Cert#: q71 �t Business Name: C4S7eM Alf Sgs r£YM S ]tic Phone: ??A 3Fag: 77A 331' 1468' owNER,s AFFIDAVIT: I certify that all of the information contained in this applicatio is co et and that all work will be done in compliance with all applicable laws regulating con tion d z g. Cu.�T�S SA MM aus PRINT OWNER OR CONTRACTOR NAME SIONA F O OR CONTRACTOR STATE OF FLORIDA, COUNTY OF S-r L u et `a ACKNOWLEDGED BEFORE ME THIS ff DAY OF �2t , 20 • BY L CC//xy WHO IS PERSONALLY KNOWN TO ME V1 OR WHO HAS PRODUCED .;� CHRISTINE & ENGUSH AS ID CATION. * MY COMMISSION R EE 859284 - sq `seat) EXPIRES: April4, 2017 111111 SIGNATURE OF NOT Y TYPE OR PRINT NAME OF NOT Y rFaf F�dR Sanded Thti Budget NotaryServices COMMISSION NUMBER � NOTICE 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 1 Revised 04/26/2010