HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:Z1,JJGJ j Lk I Fee Due: O Receipt# 1 rmit # l y da— a I R o
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECYALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 91�F � �,�Q�J gal_,
2. Parcel ID Number: —2 4oC ♦ 6l O
SC
A
St & �/F�
(/C/O C
oulvl
Office Use
section
Township
Range
Map Page
Zoning
Land Use
Initials
Only
3. Complete Description of Project or Work:
C 9 .f i
4. Owners Inforr�maatlon
Name: ( 1111A,
Address: 3011v �.
/I
City: State: (�
Zip: Phone: 70-SLd2 /G
6. Value of Construction: $ '-y. a D
S. Contractors Information
FL Reg/Cert #: ER 0000122
County Cert #: 2098
Business Name: Law's 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 regulating c6n truction and n' g
James W. Law
PRINT OWNER OR CONTRACTOR NAME GNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
r
ACKNOWLEDGED BEFORE ME THIS DAY O 20 BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED VSTATE
ET LAIN
ARY PUBLIC
AS [QENTIFICA OF FLt?RiOA
Juliet Law (Seal)m# EE846906
S A RE OF NOTARY TYPE OR PRINT NAME OF NOTARY, . 10/26/2Uf 6
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