HomeMy WebLinkAboutSUBMITTED PAPERS0 — 1
Date: �1 i Fee Due: Ilecei t# Permit # 1 0 - 4
LE. 2'�n;?x
St. Lucie Coilinty Building & Zoning
'tc • 2300 Virginia. Avenue Ft. Pierce, FL 34982-5652
4 QRID Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical
❑ Plumbing
❑ HVAC
❑ Fence
❑ Shed
❑ Demolition
P9 Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: I t%,2S--
Office Use
Only
Section
Township-E.t
n a---
- MapPage
Zoning
Land
---
3. Description of Project or Work Activity: 3 e %a /,99 .vim%% �u .t n ,.w.�` l
4. Owners Information
Name: Jan--s ,4 DLgA-,,,
Address: �-93 J /3;,?/ .1 ✓,
City: State: /C'Z
Zip: Phone:
6. Value of Construction: S 9 3,26-��
5. ;Contractors Information
FL Reg/Cert #:
County Cert#:
Business Name:
Phone 6'3'S e17 VG Fax 27z jG d IPA /y
s
owNER'S AFFIDAVIT: I certify that all of the information contained i this app ca on is rrect.and that all work will be done
in compliance with all applicable laws regulatingi tructio t onin .
PRINT QUALIFIERSIOWNERS NAME SI TUR ' OF QUALIFIERIOWNER
STATE OF FLORIDA, COUNTY or. 7— I.cJ c-t-e ACKNOWLEDGED BEFORE ME THIS C9:2 DAY OF
WHO IS PERSONALLY KNOWN TO MAR WHO HAS PRODUCED
AS IDENTIFICATION.
A/i.�/ X,6 �-% (seal)
SIGNATUR NO Y TYPl PRINT NA OF NOTARY
TITLE_ NOTARY PUBLIC COMMISSION NUMBER �'� D�I7Gtx✓
• • MICHAUL MILEY
�• MY COMMISSION 0 gE217000
SL Lucie County Specialty Permit Application rev. 8125105 dmg LXPIRLS Jury 18, 2016
4071 0 - MWAdr NWk*A0I11.
231 Bimini Dr, Fort Pierce, FL-.Google Maps Page 1 of 1
To see all the details that are visible on the
Google screen, use the "Print" link next to the map.
https://maps.google.com/ 1/27/2014
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ST. UUCIE C&NTI' BILL ING DIVISIOF,,i
RE`'+IEWEID FOR COMP CE
REVIEWS By
DATE
PLANS D P 1IT M MUST BE KTPT ON JOB
0R NO INSPECTION WILL BE NMDE.
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IN
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PILL -.-WING AND DEVELOPMENT SEI_ -CES DEPARTMENT
RR Building and Code Regulations Division
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ZeA ADDRESS: 03 / z31,?,,,v/
I, am requesting that the above permit be renewed. I
unders d that I must sch dule 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 JAYS n le -,71'6, . c fir; S /Va
If
OR
Print Name
SIGNATURE
STATE OF FLORIDA
COUNTY OF S 11- . \
ACKNOWLEDGED BEFORE ME THIS 00 DAY OF e'C
20 11I 4
By tri cin��.� \ \'t� WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
TATE OF FLORIDA, County of
SIGNATURE OF NOTWRY
DEANNA GIVENS
1P� LB i
Notary Public - State of Florida
16, 2016
M�SRAMrn. Expires Dec
`o=
Commission # EE 858761
"°,`,; to `
Bonded Through National Notary Assn.
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $.175(permit fee) x .65=$113.75 (renewal fee)
Revised 6/24/2014