HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: , 11 Fee Du? _
Permit #
PIanning & Developm "n Services
Bunlding & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-I55.3
SPECIALTY PERMIT APPLICATION
B Electrical ❑ Plumbing ❑ HVAC ❑Fence'
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2for instructions and additional paperwork required forspecialy pernriTs
1. Location/Site Address:
2. Parcel ID Number: 1306-111-0001=000/0
S
C041,
Office Use
Only
Section
Tovvnship
Range I
Map Page
Zoning
Lnnd 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 122nd Avenue
City: Miami State: FL
Zip: 33186 Phone: 878-5513
6. Value of Construction: $ :�a' �U, tTd
5. Contractors Information
FL Reg/Cert #: ER 0000122
County Cert #: 2098
Business Name: Law's Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
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OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is convect and that all work Will be done in
compliance with all applicable laws regula ' construction and zoning.
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PRINT OWNER OR CONTRACTOR NAME NATURE OF OWNER OR ONT TOR
STATE OF FLORIDA, COUNTY OF e
ACKNOWLEDGED BEFORE.METHIS DAY or 20 / � BY �$ iD, L,AL()
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED T
AS IDENTIFICATION. u
SIGNATURE OF NOTARY
COMMISSION NUMBER
4 t-- re N Air (sea 'Nn/e 5 S (seal)
TYPE OR PRINT NAME OF NOTARY
N " OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
LOVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LOUISE F{, F
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
C'Om(EPLACEMENT WITH CONTRACT UNDER S7500.00
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