HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
Fee Due:
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Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce FL 34982
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(772)462-1553 qs*f, e 'k�
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SPECIALTY PERMIT APPLICATION Co��t�
❑ Electrical
❑ Plumbing
04VA-C
❑ Fence
❑- Shed
❑ Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required forspecid& permits
1. Location/Site Address:
1 06 40—M4
s i �� / �J
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2. Parcel ID Number:
Township
Range
Map Page
�oniag
Land Use
Initials
Office Use
Section
.Only .
3. Complete Description of Project or Work: /' o-_,I� i2A O
4. Owners Information 5. Contractors Information
Name: FL Reg/Cert #: e"49- C/ Z 7 dZ
Address: n & Al- 40 %Zr SPt County Cent#:
City. jo j �� State: Business Name:
Zi r 9 Phone: one: Zi2a
p: s
6. Value of Construction: $
OWNERS AFFIDAVIT: I certify that all ofthe information contained in this application is correct and that all work will be done in
coin Hance with all applicable taws regula ' ' n and z '
PRINT OR CONTRACTORNAME SIGNA OF O OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
`5
COUbUSSION NUWER
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NOTICETOOWNER: 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 S7500Ao
Revised 04/26/2010