HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: 'S IFee Due:1 d,,,` iit I Receipt# $`0 a �termit # hj d3 --d adq
Planning & Development Services SCANNED
Building & Code Regulations Division BY
2300 Virginia Ave.
Fort Pierce, FL34982 L-NGI� CcWn(ty
(772)462-155.3
SPECIALTY PERMIT APPLICATION
Z Electrical ❑ Plumbing ❑ RVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required far specialtjf permits
1. Location/Site Addr(
2. Parcel ID Number:
a
0fllCC Use
Only
Section
To-owship
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Project or work Activity: Replace meter center with a combo pack
4. Owners Information
Name: Wynne Bldg. Corp
Address: 12804 SW 122°d Avenue
City: Miami State: FL
Zip: 33196 Phone: 878-5513
6. Value of Construction: $ JP D e H OG
S. Contractors Information
FL Reg/Cert #: ER 0000122
County Cert #: 2098
Business Name: Law's Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
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 regulating 500ruction and zo "ng
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS --r -7 DAY OF 20 /4� BY James W. Law
WHO IS PERSONALLY KNOWN TOME X OR WHO HAS PRODUCED ET LAW
ARY PUBLIC
AS I>)ENTIFIC ION.
-� (VEOFFUDMDA
T
Juliet Law (Seat)m# EEs4ssoa
SIG REOFN ARYTYPE OR PRINT NAME OF NOTARYres 10/28/2016
COMMISSION NUMBER EE 846906
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 57500.00
Revised 04/26/2010