HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONJ.
4 Date: Fee Due' (� - Receipt# Permit #
Planning & Development Services
Building & Code Regulations Division ' 2300 Virginia Ave. BY.
SCANNED
Fort(7 Pierce 1553982 St. Lucie County
SPECIALTY PERMIT APPLICATION
a Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required forspecialty permits
.1. Location/Site Address: a Xf1, A!F— 1
2. parcel IDNumber: - 1306-111-0001-000/0 t'Ft�9
offr- USE
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work Activity:
Replace Meter Center with A Combo Pack
4. owners Information
Name: Wynne Bldg. Corp -
Address: 12804 SW 122nd Avenue
City:
Miami
State:
FI
Zip:
33186
Phone:
772-878-5513
6. Value of Construction: $ 6e 0, 0
5. 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 i this application is correct and that all work will be done in
compliance with all applicable laws regulat' co structi .n and zoning
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF O R OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS S DAY OF '� 20 BY James W. Law
WHO IS PERSONALLY KNOWN TOME X OR WHO HAS PRODUCED
AS PEN JULIET LAW
Juliet Law (Seal) NOTARY PUBLIC
SIGN LIRE OF NOTARY TYPE OR PRINT NAME OF NOTARY*Expires
STATE OF FLORIDACOMMISSION.NUMBER EE 846906 Eomm lI06
10120/28/2016
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