HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION02/13/2014 13:34
7724663053
fee Due:
SEACOAST AC
Receipt# Permit #
Planning &. Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce FL 34982
(7 72)4fi2-1 553
SPECIALTY PERMIT APPLICATION
PAGE 02
❑ Electrical ❑ Plumbing El .TIVAC ❑ Fence
Q Shed ❑ Demolition ❑ Gas ❑ Siding
See pa.jZc 2 f instructions and additional puperw,rk required for specialty permits
X. Location/,Site Address:
2. Parcel ID Number: 1
Township Runge Map Pale 7nninE Land Ure Initials
Offrce Use 5ectiRn
Only
3. Cam lete Descriptio FPrgjector, WorLIKE FOR LIKE CHANGE OUT
4. Ow ers I ormation 5, Contractors Information
tiame: i « LC�t FL Rvg/Cert 9: CA001 6446
Address: LQ County Cert#: 8283
City:' ( State: Business Name: SEA COAST A/C
Zip- Phone: 77a_4 phone,- 466-2400 FIX; 466-3053
6. Value of Construction: 5
OWNER'SAFFIDAVIT. I certify that all of the in .formation contained bi this ap is on is or r tan ah all work will li he done in
vampliance with all applicable laws regulating constr cti a On' �-
,JS]HN V.. LANG_.FT,,,
PIUNT OWNER OR CONTRACTOR NAI_jE 5T{ NA OF OWNER O :ONTRACTCIR
STATE Or• FLORIDA, COUNTY-r)f ST - LUCTE
ACKNUW;L.•FT)C ED BRFURE Mr' Tj7(_1AY OP t ,J $�I
_. zI BY V LANGEL
Vj i�U S Pf RSONAU,Y KN.O' ' yT0 NIP X OR WHO HAS PRODIiCU'U ^
t IT) NT]FICATI I`- ."' _ -
NATIiR 10 � R L
t RY
SONIIII`IS$,ION MBER STATE' 0
ca�+n�,ptPg>�gEJQ�to2a
NOTICE TO OWNER' FAILURE TO RECORD A NO' )F a�,�1&3=014
CEMENT MAY RESULT IN YOUR PAYING fWf(:T FOR
IMPROVEMENTS TO YOUR PROPERTY- IF YOU INTEND TO OBTAIN FINANCTNG, CONSULT WITH YOlin
LENDER OR AN AT'CORNryy BEFORE RECORI)ING YOUR NOTICE OF COMMENCEMENT',
E)(MPT: A/C-FTEAT REPLACRINIENT WIT.g CONTRACT f1NAER S7500.00
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