HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
Fee Due:
® i;lectrieai
® Shed
Planning & Development Sen ices
Building &Code Regulations Division SCANNED
2300 Virginia Ave. BY
Fort Pierce, FL 34982 St, Lucie County
(772).t62-1553
SPECIALTY PERMU APPLICATION
® Plumbing E!rHVAC 13 ® Demolition ® Gas P
® Siding
Seepage 2 forfnvtrucrioyrS ar.oddilional
L LOeation/Site Address:
2. Parcel ID Number:
required for specialtii permits
4. onners information 5' Contractors Information
Name:
FL Reg/Cert #:
.address: `
County Cert#:
Citv: ZC� State:
Business Name:
71P' % Phone: t7 �J q'�one:
Fax:
6. Value of Construction: S -2ao—CE,
ON\'ER'S AFFIDAXIT:
""il iea in ttus application is cotreci and that all k m
worill tx done in
'1 compliance with all appheable lams regulating cons -on oning.
PRNT O�PNER OR COAiTRACTOR NA�1& mil` --- —
SIG'iATL • OP O\I?�•Elt UR COI�ITR-ACTOR
STATE OF FLORID:: COLLVTl OF -
ACKNOA'LEDGED BEFORE \IE TIUS *7 DAY" OF
-- . 20 BY
RI30IS PLRSO 41L)' IGNU%147 TO \V OR ;.740 HAS PRODUCED
CONL%fISSIO\ �IL\IgER VLZ
NUI`AR
(seal)
NOTICE TOOWNER: FAILURE TO RECORD A NOTICE OF COATLLIENCLNIENNT MAY RESLZT ITT }.OLR PAYING TV4TCE FOR
I-WROGENIENNTS TO FOLK PROPERTY. IF YOU- INTEND TO O T. N
LENDER OR AN ATTORNEY BEFORE RECOR ZT WITH YOUR
ECEIIIPT: A/C -HEAT REPLACE11tENT Timm CONTRACT 'ND 0.00 I11iEi\CE 4
Revised 04imaolo ; of %, JERALYNNE RUSS
_ _; No
Public - State o
y 'a; My Comm. Expires Jul 20717
Commission # FF 0