HomeMy WebLinkAboutSUBMITTED PAPERS1E p �w,-�t
;. St. Lucie County Building & Zoning
' ?'s 2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1553
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SPECIALTY PERMIT APPLICATION
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❑ Electrical ❑ Plumbing- ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition 0 Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 9/.3"'? L/mv�s 1< tz
2. Parcel ID Number: 33,72~ 2a7 - e607 - v60 Z
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Map Page
I Zoning
Land Use...
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3. Description of Project or Work Activity: "r."I 1, R Oct
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4. Owners Information
Name: / /,-, oC L�S�
Address: ,S— ItJ000 -106-f Or
City: e%%-, State: /v l�
Zip: Dad 5— ) Phone:
6. Value of Construction: $ A�06.6r'
5. Contractors Information
FL Reg/Cert
County Cert#: 29-!5'7 3
Business Name: 19m e i a y
Phone r'33 'o700 Fax 27Z-
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 regulating", struetio 2onin .
PRINT QUALIFIERS/OWNERS NAME SI TU ' OF QUALIFIERIOWNER
STATE OF FLORIDA, COUNTY OF/ J / L U C 14 ACKNOWLEDGED BEFORE ME TIES 0_:DAY OF
�,aiuv.7� 201`L, BY,��nr� L iccr s7r, WHO IS PERSONALLY KNOWN TO ME R WHO HAS PRODUCED
AS IDENTIFICAT/ION.
//� (seal)
SIGNATURE OF NOT TYPE OR'PRINT— NAME OF NOTARY
TITLE: NOTARY PUBLIC
St. Lucie County Specialty Permit Application rev. 8/25/05 dmg
COMMISSION NUMBER rlZ—
MICHAEL MILEY
••'_ MY COMMISSION * EE217600
EXPIRES July 16. 2018
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DATE T 1VdU6I BE APT ON JOB
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8132 Links Way, Port St. Lucie. FL - Google Mapg
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