HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due: Recei t# Permit it -' m
E �aa-F.
St. Lucie C41 uty Building & Zoning
2300 Virginia Avenue Ft. fierce, FL 34982-5652
' "IIKv Tel.561-462-1553 �
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SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition I Gas ❑ Siding
Seepage 2 for.instructions and additional paperwork required for specialty permits
1. Location/Site Address: -l110 PL4c.-�ez �!
2. Parcel ID Number:
-Office Use
Only
Section
Township-
-Ran a--
Map -Page
Zoning
Land. Use._
3. Description of Project or Work Activity: a o % .- /� ✓ e �j— i
riltiii 74 zi/C 15,$ ..P x' / e' /`i Ge/a� Syl.t�- 2W
4. Owners Information
Name: �Giy�- � 0-12czd
Address: ,_�,
City:'(Q d State:
Zip: -V 9 si Phone:
6. Value of Construction: $
5. ,Contractors Information
FL Reg/Cert #:
County Cert#:'99
Business Name:
Phone: �� Fax 2 9 Z- ys/�
OwNER's AFFIDAVIT: I certify that all of the information contained i this app1ica#bn—isbqrrect and that all work will be done
in compliance with all applicable laws regulating; tructi )i zoniAr.
PRINT QUALIFIERS/OWNERS NAME SI TU OF QUALIFTER/OWNER
STATE OF FLORIDA, COUNTY OF 97: Z"i' i t ACKNOWLEDGED BEFORE ME THIS d 7 DAY OF
204, BY 4 rrJ L C4 �IHOIS KNOWN TO ME R WHO HAS PRODUCED
AS IDENTIFICATION.
Z-/ / Ni,�_ (seal)
S GNATURE O Of TYPE' OR' PRINT NAME OF pi TARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER 6f 12124
MICR EA L MILEY
MY COMMIS41ON 0 EEZ17800,
St. Lucie County Specialty Permit Application rev. 8125/05 ding EXPIRES July 18, 2016
1-0113 FWgftN
ST. LUCIE CGIJNTY BV DL\O DIVISIG i
REWE WED FOR C® DICE
REVI E0LN1SPEC
BI' _
DATE
PLANS �'12T fvfL ST BE KEPT ON JOB
OIL NO) !O-.� WILL BE W DE,
�11,10,4 l
/ , �t
(7�"`
Ci�
11953 S Indian River Dr, Jensen_ Beach, FL - Google Maps
Page 1 of 1
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To see all the details that are visible on the
screen, use the "Print' link next to the map.
https://maps.google.com/ 1/24/2014
OFFICE USE ONLY:
DATE FILED.
REVISION FEE:
SCANNED
BY
�t. Lucie county
PERMIT #
RECEIPT #
PLANNING & DEVRLOPMMT SERVICES
BVII.DING & COOE REGULATION DIVISION
2300 VMGINIA AVENUE
FOIRTrWRCI:, FL 34982-502
(771) 462-XW
&ITLICATION I?OR BUILDING PERMIT REVISIONS
PROJECT 11WORMATION
X. LOCATION/SITE
2. DETAILED DESCRWTION OF PROJECT ANN
REVISIONS;
+.Vgal j6Ae% pir T 1.c/.dS ic/Rjs
3. CONTRACTOR INFORMATION:
STATE of FL. REGJCERT. & �y
BUSINESS NAME:
QUALIFIERS NAME: —
ADDI=EMS: U
CITY: ~ ,*r..r
PHONE (DAYTIME) 7. �z.
4. OWNER/SU1LOER INFORMATION:
NAME-
ADDRESS:
CITY$
PHONE:
5. ARCHITECT/,ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (OATTIME):
SLCCC_ 9/23/09
Revised 04=010
ST. LUCIE COUNW CERT. #:
STATE:
FAX;
STATE: ZIP;
FAX:
STATEi
Aw
ZIP:
m
am 0343
ST LUCIE COUNTY BUTI.Dn G DIVISION
REVIEWED FORCOIZ CE
REVIEWED BY
DATE, e=aAZA3j---,
PLANS AND FEMITT.MLST BE KEPT ONJOB
OR No DiSPECTIGN WILL BE MADE.
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Cade Regulations Divigion
• 2300 VIRGINIA ,AVIr.
• FORT PIERCE, FL 34982
(722, 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ADDRESS: �� �. 1
I, am xequestin� that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
SIONATURE
,IRrr fl
Print Nam
STAVE OF FLORIDA
COUNTY OP Sr 1�. cr✓
ACKNOWLEDGED BEFORE ME THIS � DAY OF _ AuI a s . 20—IY
BY -, R r�to t15 1� r WHO Is PERSONALLY KNOWN TO ME —,YJ OR
HAS PROVIDED AS IDENTIFICATION.
MICHAEL 1A1LfiV
q� • - MYCOMMOSION42EHIND
SEAL gxPiRI8 Jdy % 201$ .
� iss
FOR OFFICE USE ONLY!
Number of Open Inspections: 60
Total Inspections:
(I31vidc open by total to get % of open inspections)
Percentage:
Original permit £ee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65-$113.75 (renewal fee)
Rovisc4 02412014