HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: 1 Fee Due: `' �( IFeceipt# 'ermit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. SCANNED
Fort Pierce, FL 34982 B �,
(772)462-1553 St. Lucie County
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing 04 VAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and addidon�alt erwork required for specialty permits .
1. Luca tion/Site Address:
2. Parcel ID Number:
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
PP
Zo
3. Complete Description of project or Work: L%/'ce— Uke- K,,n ldsecr
lso$c 00 '
4. Owners Information Q,� 5. Contractors Information
Name: . ¢ l' l FL Reg/Cert #: C 1q C O 51210
Address: kf a el a IJki -111N Z County Cert#: 11 Q71,�
City: PdCi� State: FL Business Name: I.QS'rbm A to 3gsT£ri15 INC.
Zip: 0µggb Phone: Phone:771 335 3Ua Fax: 77A 935' 1 Qb8-
6. Value of Construction: $ V—/ 0 Q /
owNEws AFFIDAVIT: I certify that all of the information contained in this application is c erect and that all work will be done in
compliance with all applicable laws regulating con 'o and Mg. _.
Cu.�rls S� 1HM oNs
PRINT OWNER OR CONTRACTOR NAME siGNATUM OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF ST L v eI `& , / , (�
ACKNOWLEDGED BEFORE ME THIS / DAY OF , 20 f 7 BY _ [. el-[/S �/ �1b!%% ,q y
WHO IS PERSONALLY KNOWN TOME �I OR WHO HAS PRODUCED
�6 ::;8�.� CHRISnNE R. ENGUSH
AS ID ICATION. MY COMMISSION t EE 659284
i 7 jPIRES: ApdI4, 2017
SIGNATURE NOT Y TYPE OR PRINT NAME OF ARY"'�aa �EaP`Op d tha Budget NotarySenice�
COM CSSIONNUMBER��
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. hF 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 S7500.00
Revised 04/26/2010