HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION2014-01-25 11:12 IMBODER f 17724607522 » P 2/2
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Date:
/ I �RKI
COUNTY "'
F L 0 R I D A
Fee Due: I Recei `O 104) Permit # 2
Planning & Development Services
Building & Code Regulations Division SCA YN,,C
2300 Virginia Ave. B
Fort Pierce, FL 34982 fit,
(772)462-1553 facie Coupty
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing ❑ HVAC ❑ Fence
17 Shed ❑ Demolition ❑ Gas ❑ Siding
See page Z for instructions and additional paperwork required for specialty permits
1, Location/Site Address: \'GYM � V, b fz x \J �.
2, Parcel ID Number: no u 'A 000
0fJlC(? 11yp
Only
Section
TO 15111P
Range
Map Page
'Zoning
band [ISO
Initials
3. Complete Description of Project or Work:
1>Du) e'r
1.AC, t 2
4. Owners Information 4, Contractors Information
Name: n , �a R, q o,�n b FL Reg/C:ert #:
Address: - 0)2)S ry-% rri t `•L�� County Cert#:
EP- 161D1`-i 01S:
City: l�ocL �l ((cam State: � Business Name: l i 2 c 6p l C_- ,1 " C_
Zip: { Phone:-21x90'Tr7(0 Phone 7).\ "�aq So�ax: -1, �L qa`i L IC q
6. Value of Construction: $ 3 5 P
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 construction and zoning,
a A 0
PRINT OWNEK 6R CONTRACTOR NAME SIGNATURE. OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY 01; '54- 6Lze l Q�
ACKNOWLEDGED BEFORE MF. TI115 , „ � 1 DAY OF _ -I 20 1 ` , BY ��' � U-1 L4
WI101S PERSONAI.I,Y KNOWN'ro MF. �, OR,WHO HAS PRODUCED .. .�$EL A DRARM
IDENTIFICATION, `: MY COMMISg1014 0 EE118174
EXPIRES August 02, 2015
,N t1RE OF 07'A CYYE UR PRINT NAME Ol NU'rARY I 1� 41gN9W rVa.com
COMMISSION NUMBER b
NOTICETOOWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOi1R PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSLILT WITH YOUR
I,F,NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C'OMMF,NCRMF.N't',
EXEMPT: A/(:.HEAT REPLACEMENT WITH GUNTRACI' TINDER $7500.00
Revised 04/26/2010