HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: + a!_ 9P I Recei t# Permit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553UC/& CO
SPECIALTY PERMIT APPLICATION Unty
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ® Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 2808 S 28th Street
2. Parcel ID Number: 242080200780005
Office Use
Section
Township
Range
Map Page
Wing Lan Use
Initials
Only
3. Complete Description of Project or Work: r �,mo 0}CA-)'tL�/
4. Owners Information 5. Contractors Information
Name: Bank of New York Mellon FL Reg/Cert #: CGC 45370
Address: One Home Campus County Cert#: ;2 ac�z—_�
City: Des Moines State: IA Business Name: GTF Builders, Inc
Zip: 50328 Phone: 803-396-4368 Phone:305-251-5466 Fax:305-251-8218
6. Value of Construction:
OWNER'S AFFIDAVIT: I certify that all of the information contained in this app ' ation ' orrect and that all work will be done in
compliance with all applicable laws regulating cons cti d zoning.
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PRINT OW R OR CONTRACTOR NAME SIGNATURgeOT OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF -M l na m I (%1� II
ACKNOWLEDGED BE OREMETHIS �J DAY OF 20 BY \�ll�t YQQ }'l� n
WHO IERSONALLOWN TO ME OR WHO HAS PRODUCED
*0101if
YUNIA PAEZ
NOTARY PUBLIC
BTATE OF FLORIDA
Comm# EE083842
Expires 4/13/2015
AS
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TURE OF OTARY r� /J
QSSIONNUMBER EE l7 S 38 1 L
IUVIIa P60z-
TYPE OR PRINT NAME OF NOTARY
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