HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION02/18/2014 15:28 7724663053 SEACOAST AC
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bate: Fee Due: Receipt#
........... Planning & Development Services
J _ = Building & Code Regulations Division
�. 2300 Virginia Avc.
_ Fort Pierce, FL 34482
(772)462-1553
a�NIJNEU .
PAGE 02
Permit 0
�b�le
By SPECIALTY PERMIT APPLICATION
St. Lucie COunty
CJ Electrical ❑ Plumbing Li RVA.0
❑ Shed 0 Demolition ❑ Gas
Seepage 2 fo)r insstjructinns U
ditionalrpap�erm,ork
I. Location/Site Address. '�1G\ 4 �1
2. Parcel iD Number:
❑ Fence N
❑ Siding
yuned forspecialty permii)j�ty�
-er
C?
Office Use
Only
Section
Tn+smsl+lp
Range
M.ap T?+Igc
7011ind
band Use
inilinlc
I Com lete Descri tion of Project or ork• LIKE FOR LIKE CHANGE OUT
4. Own rs information L6 �^ 5. Co actors Information
Name: { � � 1r I, lteg/Cert #: CA9016446
--
Ai clrcSS: 4 County Cert#: 8283
City: State: 111 Business Name: SEA COAST A/C
Zip. Pbone: w2-S —wphone_ 4 6 6 - 2 4 0 0 Fax: 466-3053
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6. Value of Construction: A
OwNXR'S AFFIDAVIT; 1 certity that al,l of th.e mtoYYfat:+oo WntalnCcl in thIS appL= n s cl
compliance with all applicable Iaws regulating constructio w zor
70HN V d�AI�E.L.,_
PRiNT OWNF..R OR. C ONTRACTOR NATAE SIGNATURE OF 0 NER OR Cf
SUTTEE OFFLORIDA, COUNTY Or ST' .UCIE
NOWi.I DGED TI-My Y OF 6 ZO BY JOHN iI
F..
6
WEit is PE ALLY KNOW, qI: WHO HAS PRODiICF..p
1 1.FiCATIQN.
Ri'3•CY LANU
CRT,
c� TE OTARY TYPE OR PRINT NAME'OF NOTARY
COMMIS UN p UMBEyCJ
I work will be donc in
LANGEL
NOTARY PUBLiC
STATE OP FLQRIi A
Explres 8130=14
NQTTCr,TOOWNER: FAILURE 7'0 RECORD A NOTICE OF COMMENCUKENT MAY RF..SULT IN YOUR PAYING TVVTCIi FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING. CONSi LT WiTii YOUR
1,ENDER OR AN ATTORNEY .BEPOIRE RECORDING YOUR NOTiCT OF COMMENCEMTNT-
UXEVPT' .VC HFAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/262010
1
TRANSMISSION VERIFICATION REPORT
TIME 03/09/2002 19:43
NAME
FAX
TEL
SER.0 BROF3V449734
DATEJIME
03/09 19: 42
FAX NO./NAME
94663053
DURATION
00:00:54
PAGE(S)
03
RESULT
OK
MODE
STANDARD
ECM