HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONO{. NTY
F 1, O P. I D A
Pee Due.- Receipt# ?. Permit #
PIanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. sC,�
Fort Pierce, FL 34982
(772)462-1553 St �Gc/&), F6
0
SPECIALTY PERMIT APPLICATION C°4n01
M Electrical ❑ Plumbing ❑ RVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork regr,,iretl for specialtji permits
1. Location/Site Address: 07 T Dp�G
2. Parcel ID Number: -3 ell 0 0& —?
Ofllcc Use
Suction
Tommship
Range
11ap Page
Zoning
Land Use
Initials
Only
3. Complete Description of Project or work Activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 12804 SW 122°d Avenue
City: Miami State: FL
Zip: 33186 Phone: 878-5513
6. Value of Construction: $ /,0,00. a O
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 co ruction and zonin Of
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OP St. Lucie -
ACKNOWLEDGEDBEFOREMETHIS��DAYOF 20 / �BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JULIET LAW
AS I ENTIFICATI �Y PUBLIC
STATE OF Fti?RiOA
Juliet Law (Seal) Comm# EE84690u
S► E OF NOTARY TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER EE 846906 EVIrres 10/28/2016
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT NIAY RESULT 1N YOUR PAYING 11VICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM141ENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT NVITI1 CONTRACT UNDER S7500.00
Revised 04/26/2010