HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONJ
Date: '+ee Due: Recei t#�ei•mit #
Planning & Development Services
Building &Code Regulations Division ��j
2300 Virginia Ave. ((
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding SQ.8 y
St.
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Seepage 2 for instructions and additional paperwork required for specialty permits UC/E? COGnt
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1. Location/Site Address: 5807 Myrtle Dr., Fort Pierce, FL 34982-7539
2. Parcel ID Number: 3402-609-0313-000-9
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: Build Electrical Service for new shed €;�—tn Fle c",
4. Owners Information
Name: Phillip & Jennifer Hale
Address: 5807 Myrtle Dr.
City:
5. Contractors Information
FL Reg/Cert #: EC0002956
County Cert#:
PSL14*4470
Ft. Pierce State: FL Business Name: Applebee Electric
Zip: 34982-7539
Phone: (772) 971-1352 Phone: (772) 466-7930 Fax: (772) 466-3765
6. Value of Construction: $
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 r , ulatin onstru tion arA zo
OLT
PRINT OWNER OR CONTRACTOR NAME GNAT OF OWNER OR CO ACTOR
STATE OF FLORIDA, COUNTY OF ! �,
ACKNO I TG) D S DAY OF 20 ! /, BY i
O IS P RSONALLY KNOWN TO E OR AS PRODUCED
I NTIFICATION.
,oi x:y A ELF: 09. HLI'(s'eal)
SIGNATURE OF N TARY TYPE OR PRINT,NA OF NOTA aeMY COfl�i95i(ii ta' OB; 53D
t't o`f EXPIP,ES: Apiii 1�', 1015 f
COMMISSION NUMBER
%ARP OgQ••� Bonded Thru Notary Public Undomite�rt
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