HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: Fee Due: - 0 p lReceipt# I0 A0 Permit # 1 y O - 64 0
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. a51
• , Fort Pierce, FL 34982 c'Q/�/
(772)462-1553
0
SPECIALTY PERMIT APPLICATION C°1111�y
❑ Electrical ❑ Plumbing ® HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 6105 Bamboo Dr Fort Pierce FI 34982
2. Parcel ID Number: 3402-610-0493-000-8
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: Install New Trane 3 Ton 16 SEER Air Handler And Condensing
Unit Like For Like 10 Kw Heat
4. Owners Information
Name: Thomas & Slavica LaPenter
Address: 6105 Bamboo Dr
City:
Fort Pierce State: FL
Zip: 34982
6. Value of Construction: $ 4,875
5. Contractors Information
FL Reg/Cert #:
County Cert#:
Business Name:
CAC1816883
26958
14701
Phone: (772)267-0026 Phone: (772) 878-0425 Fax: (772) 878-0325
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 cons ion g.
David Poling
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWN OR RACTOR
STATE OF FLOMA, COUNTY OF Saint Lucie
ACKNOWLEDGED BEFORE ME THIS 29th
WHO IS PERSONALLY KNOWN TO ME X
AS IDENTIFICAATION.
l
9IGN TURE OF NOTARY
COMMISSION NUMBER EE134744
DAY OF September 20 14 BY David Poling
OR WHO HAS PRODUCED
Nicholas Albers
TYPE OR PRINT NAME OF NOT
NICHOLAS ALBERS
MY COMMISSION # EE134744
[(407
EX h September 29, 2015
1398 0153
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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.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010