HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: "4L1G j Fee Due: s , aRecei t# Permit # lyd - d'3ro
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. C'
Fort Pierce, FL 34982 9
(772)462-1553 Fax 462-1578 ��p . �L 2
SPECIALTY PERMIT APPLICATION o��L
❑ Electrical. Xplumbing ❑ HVAC ❑ Fence
❑ Shed* . ❑ Demolition ' ❑ Gas ❑ Siding
Seepage 2 for• instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number:
3. Complete Description of Project or Fork: 2�5,�6 J�5 US L) JG 1„j
4. Owners Information 5. Contractors Information
Name: j;Am4i�" mc— FL Reg/Cert #: f 11 D !P 9C7
Address: bR— County Cert#: ����// 0,6
City: �pRt �► (61C 1'S State: FL -Business Name: C4r) 5 > eLe 1- J61 A&b�-N
Zip: Phone: 1" Q -P6%- 00 Ll ) Phoneo. -7 J t61^ 31-72�-ax:
6. Value of Construction: S
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct
compliance with all applicable laws regulating constry4ion and zoning.
all work will be done in
PRINT OWNER OR CONTRACTOR NAME / SIGNATURE OF OWNS OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF ' 31 �p /[ %
ACKNOWLEDGED BEFORE ME THIS � DAY OF 20� BY CAR I <5 i0 j2 ! E' � � O /1 4 E 0 y—
WHO IS PERSONALLY KNOWN TO ME D
AS ID ICATION. /�
l . q � /7 Y L , Pp, ,c,, a (seal)
SI NA OF NO ARY TYPE OR PRINT NAME OF NOTARY
COMMISSION -NUMBER CAROL ANN PEARSON
' •,`• MY COMMISSION #FF071097
*ALL RESIDENITAL AND NONRESIDENTIAL STRUCTURES AM
\ ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE RO • i ° .. ' structions on
\ reverse side of this sheet)
\ evised 04/1712014
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.
EXEMTT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7,500.00
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 stnicwtal
alteration. The information to be provided with this application includes:
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
Indicate the street address or general location of
property where the.building activity is taking,place.
Indicate the tax identification number of the
property where the. building activity is taking place.
Fully describes the activity to take place.
Indicate the name and address of the owner of the
property on which activity is taking place.
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 lab -or costs associated with the
buildirig/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 No attachments necessary
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.NI ..Eor_assistance in completing this application, please call (772)
462-1553, during regda% o'ff ce hoists_(8 QQ,IvI =; S':OO;PM), Monday through Friday.
Uponissuance of this-'permiit; requireddnspections-ban be scheduled by calling 1-866-284-1280 or logging on to
http://codeinspectfonpublit,stlugieco ggv