HomeMy WebLinkAboutSUBMITTED PAPERSDate: I Fee Due: I Receipt# II Permit #
Planning & Development Services
Building & Code Regulations Division SCAAJNe0
2300 Virginia Ave. 13Y
Fort Pierce,
FL
3 982 S , ��Ol� COUnty
SPECIALTY PERMIT APPLICATION
❑ Electrical Plumbing ❑ RVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 11 4F P V\ cA r ba Lty W t
2. Parcel ID Number: y 4 at, - 5 t 0- 0 o air• p O D• g
Township Range Map Page Zoning Land Use Initials
Office Use
Section
Only
3. Complete Description of Project or Work: QW1a e. � =M_.f a1
4. Owners Information 5. Contractors Information
Name: &beC4 % 1 LIDS FL Reg/Cert #: �to b-1
Address: A&LAq o % hour 1CActe. 5WO County Cert#:
City: State: Business Name: 2�
Zip: 3Llgga Phone: Phone: U &� Fa "�)4 l �1 1� ✓)
e
6. Value of Construction: $ ASO�
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
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liance with all applicable laws regulating cons c ' nd zoning.
PR11VT OWNER OR CONTRACTOR NAME OF O RA
STATE OF FLORIDA, COUNTY OF ft �
ACKNOWLEDGED BEFORE ME THIS a�` DAY OFO QJ- 20 1 4 . BY bb Q r� UJ l 1.1 m
WHO IS PERSONALLY KNOWN TO ME�R WHO HAS PRODUCED
hENTIFIC TION. �ytiir�fi{h; RHONDA LAFFERTY
O ��` "t •`e MY COMMISSION kFeei:1P`•4297
SIGNA OF NOTAkY TYPE OR PRINT NAME OF NO ., �.EXPIRES January OS, 2017
COMMISSION NUMBER ee&Skcl� (407) 39"153 FtoddaNMeryServlce•com
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
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