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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION;Permit # Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing HVAC ❑ Fence St ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: f&&� 2. Parcel ID Number: / ` S0O "0,0100 —45©o SCq ey�Fo <4Cie CCU sty Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Complete Description of Project or Worl 4. 4t-✓ Owners Information 5. Contractors Information Name: �f Address: 16P &1��lAWfA&2 & sL2fA /� City: AS htooil State: &ay Zip: SV bT 5 Phone: d Id 6. Value of Construction: $ Q FL Reg/Cert #: C 1qC D$ 41 D County Cert#: q? 1 b Business Name: 1. y-nom A i r SSS T£ YM S 1 N e Phone: T?A 33S 313a Fag: 17A $�S 1 Q68' OWNERS AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance with all applicable laws regulating coon and l�- Ctd,r-T%5 Sp MrA aj-. C PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ST LQu et -.&��` ,/ 31 (� ACKNOWLEDGED BEFORE ME THIS /7 DAY OF , 20 . BY �L��IS WHO IS PERSONALLY KNOWN TO ME V1 OR WHO HAS PRODUCED AS IDENTIFICATION. / / a°�;.R �p:;°�% CHRISTINE R ENGUSI., e/�T "/i,- � ��w /J'`j * (§eJtCOMMISSl0N # EE 85%; SIGNATURE OF NOT Y TYPE OR PRINT NAME OF NOTAR ^raj nr XPIRES: April 4,2017 r FOF R�" 90n9ed Thm BuAget Notary Sen^•. 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 Revised 04/26/2010