HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONi
Date: Fee Due: Recei t# Permit #
Planning & Development Services uy - 0�)*'
Building & Code Regulations Division C,qN
® 2300 Virginia Ave. B ED
. FortP Pierce, FL 3 982 Lucie Count
Y
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing M-nvAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 foor instructiions, )and additiOyd;��W
onal paperwork requir Ied,,f_or specialty permits
1. Location/Site Address: ax ! V�W'f 5 L,FCiI-TI, �C. eh' FC
2. Parcel ID Number: Z�a'':5p1-- (xxo— l —p
Township
Range
Map Page
Zoning
Land Use
Initials
Office Use
Section
Only
3.
4. Owners nformatlon
5. Contractors Information
Name: s L �Pn L W&h
FL Reg/Cert #:
Address: owAgwe,
County Cert#:4-1
�S
City:
State:
Business Name:
4dy�4 41r.
Zip: 4170
Phone:
Phone: 40,'�- Ifa& Fax: T P—q61kT-q1 VJ
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
compl' ce with all applicable laws regulatin nstruction
EZ /•
PRINT OWNER OR CONTRACT A04 NATURE OF O OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF\, )WIF
ACKNOWLEDGED BEFORE ME THIS * DAY OF
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
GNATURE OF NOT Y
COMMISSION NUMBER d_r9 b T A(A5q
20IV BY
TYPE OR PRINT NAME OF NOTARY �i?Orgp� :.1Boro
p
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