HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION,!Date: a 1 tj 11{ I Fee Due: P i j _:� p R�cei t#
Planning & Development Services
Building & Code Regulations Division �CA/V/���
2300 Virginia Ave. B
Fort Pierce, FL 34982 t. UCj Y
(772)462-1553 G
SPECIALTY PERMIT APPLICATION
10 Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: `t_� —�� f— /?0
Office Use
Only
Section
To,.vnship
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Project or work activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 90C>0 --a- / =W,;40.2
City: State: FL
Zip: �Y�S� Phone: 878-5513
6. Value of Construction: $
S. Contractors Information
FL Reg/Cert #: ER 0000122
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 regulati c nstruction and zoning
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS _ ZQ DAY OF 20 / 4, BY James W. Law
WHO 1S PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JULIET LAW
AS ID NTIF AT[ON. V NOTARY PUBLIC
o STATE OF FLO[iiOA
Juliet Law (Seal) 919TOW Comm# EE846906
SIGITATIJRE OF NOTARY TYPE OR PRINT NAME OF NOTARY EXpireS 10/28/2016
COMMISSION NUMBER EE 846906
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