HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION02/18/2014 14:30 7724663053 SEACOAST AC PAGE 02
41 094a5
Date: Fee Due: Receipt# Permit # _1
Planning & Development Services
`• �- Building & Code Regulations Division
2JO0 Virginia Ave.
Fort Pierce, FL 34982 8
(772)4<i2-15CA�53 /V
�e. 4
SPECIALTY PERMIT APPLICATION c/c;e
count
Q Electrical Q Plumbing ® HVAC Q Fence
Cl Shed Q Demolition Q Gas Q Siding
See pngrt 2 for instructions Wid additional paperwork required for specialty permits
L Location/Site Address:
2. Parcel ID Number, . T L—A � L l (J[ )J� (���
Office Use
Only
.Serdon
Township
RAnge
M510 p>lge
Zoning
f mod Usc
Initlals
3. Conapi to Descriplir�
t
4. Ow ers nfoirmatiion
Name: % I rmif 1c
of Project or W
Address: c__J
City:
Zip.
6. Value of Construction: $
LIKE CHANGE OUT
5. Contn(dors Information
1-state:
FL.Reg/Cert #:
�-�C j" County Cert#:
ttG '-�j �,, //�� Business Nettle:
1Pho ne: R�10"" �-iJ�JJ"11s- i, lie. 4 6 6 - 2 4 0 0
OWNER'SAFFIDAVIT; I certify that all of the information contained in this
compliance with all applicable laws regulating cony
JQHN V., LAN(ZEI _
PRINT OWNER OR CONTRACTOR. NAME- SIGPq Tl IR-
STATE OF FLORIDA. TY 01, T . LUCIE P
- -.--b
ACKNOW , a1]i it i7 UEFORF. I S DAY Q 1�
I. PERSONALLY N TO ME X OR -10 1-IAS PROD(JCr0
A; D' TIFTCA n ,
Revised 04/26120111
TYPE OR
LR
CAQp16446 M`
8283
SEA COAST A/C
Fax: 466-3053
will be done in
_ gY JOHNy't7 IaNG3E LA[V�EL
�. NOTARY PURL,IC
Cornm# EE021924
EXPIres 8130MO14
LANGEL.- (seal)
1ME 01"- NOTARY
R: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESIJUr IN YOUR PAYING- TWICE FOR
t.MFROVEKENTS TO YOUR PROPERTY. IF YOU IN'i't;N.I) TO OBTAIN R ANCINC.., f ONSiJ1;I' WITH YOUR
LENOEXR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM.MENCF,MENT.
rXEMPT: A/C -HEAT RPPLACEMENT WITH CONTRACT TINDER F7500.00
TRANSMISSION VERIFICATION REPORT
TIME 03/09/2002 18:25
NAME
FAX
TEL
SER.# BROF3V449734
DATEJIME
03/09 18: 24
FAX NO./NAME
94663053
DURATION
00:00:55
PAGE(S)
03
RESULT
OK
MODE
STANDARD
ECM