HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: Fee Due',' Recei t# Permit #
Planning & Development Services Jq0 L°-) (401
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
4%
SPECIALTY PEP -AM APPLICATION
S Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paper►vork required forspeciaUy permits
1. Location/Site Address: o� U
2. Parcel ID Number: 130f111-0001-0001Y
Office Use
Section
Township
Range
I
Map Page
zoning
Land Use
J
Inifialy
Only
I
.
3. Complete Description of Project or Work Activity:
Replace Meter Center with A Combo Pack
4. Owners Information S. Contractors Information
Name: Wynne Bldg. Corp_ FL Reg/Cert #: ER 0000122
Address: 12804 SW 122ad Avenue
City: Miami State: FI
.Zip: 33186 Phone: 772-878-5513
6. Value of Construction: $ e 0-0. t30
County Cert #: 2098
Business Name: LaWs Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
OWNER'S 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 re;GNAITSTRE
'g construction and z g.
PRINT OWNER OR CONTRACTOR NAME OF 0 OR CO CTOR
STATE OF FLORIDA, COHIUNTY OF -, -�°l�P �D' l *� NPr�\10,
ACKNOWLEDGED BEFORE ME TS OTC C� DAY OF , 20 / BY W . ro
WHO IS PERSONALLY KNOWN TOME V OR WHO HAS PRODUCED
AS IDENTIFICATION.
i� %1fL �d�rc t-• .
SIGNATURE OF NOTARY
COMMISSION NUMBER
T
TYPE OR PRINT NAME OF NOTARY
NOTICE TO OWNER: FAILURE. TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.6o
Revised 04/26/2010