HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: 1 �-j tii_ Fee Due: Q O Receipt# 9 7075 (Permit # 1 i d _p�5
Planning & Development Services S
Building & Code Regulations Division CgNF�
2300 Virginia Ave. Ste Y
Fort Pierce, FL 34982 . <<�Cie
C (772)462-1553 Oun ty
SPECIALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Addr(
2. Parcel ID Number:
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
-
3. Complete Description of Project or Work:
4. Owners Information
Name: /./�C!'//�
Address: ��d�a S , b/6 I 'q- 4 6 —'Z
City: State: '`� /
Zip: p Phone: .3
6. Value of Construction: $ /O ! , Z)y
S. Contractors Information
FL'Reg/Cert #: ER 0000122
County Cert #: 2098
Business Name: LaWs Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
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 regulating4nstruction and zoning
James W. Law
PRINT OWNER. OR CONTRACTOR NAME SIGNATURE OF'OiVNIrR OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS _ 7 DAY OF 20 / 7 BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED VExplre
ET LAW
AR
Y PUBLIC
AS I ENTIF TE OF i=Lt?RipA
Juliet Law (Seal)m# EE846906
StW RE OF NOTARY TYPE OR PRINT NAME OF NOTARYCOMMISSION NUMBER EE 846906s 10/28/2016
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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.
EXEI4IPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500.00
Revised 04/26/2010