HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: / id 7//y_ I Fee Due: Q C) Receipt# !11(3 .{, "Permit # 1101 — 103 y
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
¢ (772)462-1553 /,. ��Co
SPECIALTY PERMIT APPLICATION
❑ Electrical L'Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: �� N e AL-" if ►/i i
2. Parcel ID Number: S "Se/0 006
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work:
%&/14 C 02 YD C j/C, t '44-/e ' S-e" c
M
4. Owners Infyo�rmation ' 5. Contractors Information
Name: !� i d' '�—. gAc t M
Address: 16 S' A,"ff
City: Ps L. State: r e—
s
FL Reg/Cert #: iL /c 110 7
County Cert#: c; S� Q
Business Name: Ce.-t .P-S ;-t' L 6zsa. L y„ SCh„�f
Zip: 3 Gt IJ: .3- Phone: -!;' 2 ® " /f 0 C. Phone: -3 3 % - 69& Fax: 3 3 s o2 6 o0b
6. Value of Construction: $ -r.4 —'o , G`q
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.
PRINT OWNER OR CONTRACTOR NAME c- S GNATURE OF OWNER OR CONT-RpM-A
STATE OF FLORIDA, COUNTY OF !f13r
ACKNOWLEDGED BEFORE ME THIS a \" DAY O 'T '
WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED
AS IDENTIFICATION.
Z ' \/ >Z d►
SIGNATURE OF NOTARY TYPE OR
COMMISSIONNUMBER VCL44%'AG
20 \' _BY1osAkoh'iu\1Ni
y oo-. l-►de �e. ek - 36 4 -- o
111 p 'q
�f 2,• �`�
DEANNA GIVEN
Notary PubliQseMtate of Florida
NAMEOFNOTAR ; .. o
i
MY Comm. Expires Dec 16, 2016
,le OF FIB:°�
Commission # EE 858761
Bonded Through National
Notary Assn,
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TRIC ' NMR
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
NOTICE TO OWNER: FAIL', TO RECORD A NOTICE OF COMMENCEMED', . -,AY 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 Wrm CONTRACT UNDER $5,000.
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or blue ink
only) or typed. This permit application is to be used only for those activities that are not otherwise included
under a primary building permit. This application may not be used for any activity that includes structural
alteration. The information to be provided with this application includes:
1. Location/Site Address
Indicate the street address or general location of
property where the building activity is taking place.
2. Parcel ID Number
Indicate the tax identification number of the
property where the building activity is taking place.
3. Description of Project or Work Activity
Fully describe the activity to take place.
4. Owner Information
Indicate the name and address of the owner of the
-
property on which activity is taking place.
5. Contractor Information
Indicate the State of Florida registration number (if
applicable), St. Lucie County contractor license
number and the name of the business doing the
work.
6. Value of Construction
Indicate the total value of the work to take place.
Total cost of construction includes all current retail
material and labor costs associated with the
building/construction activity. Construction value is
used to determine the permit fee. -St. -Lucie County
reserves the right to question and/or modify the
indicated value of construction if it is demonstrated
that the submitted figures are -not consistent with
similar types of construction.
❑ Gas~ Attach 2 piping schematics with tank size,location, and BTU of each appliance
❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications
❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence
❑ Siding Attach 2 copies of manufactures specifications
❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement
This application can -be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 34982. All permit applications must be filled out completely before submission. No applications will be
:accepted "for processing after 4:30"P.M. For -assistance -in completing this application, please call (7.72)
462-1553, during regular office hours (8:00 AM - 5:06 PM), Monday through Friday. "
NOTE. Emergency electric service change out inspections will not he performed after 3r00 PM without
special arrangements and additional fee paid.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.