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HomeMy WebLinkAboutSUBMITTED PAPERSDate: I► fl Fee Due: /,ry / I Receipt# ;Permit # Planning & Development Services Building & Code Regulations Division SCq 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Fax 462-1578 L4Cie CoUnry APPLICAT ❑ Electrical ❑ Plumbing ❑ HVAC El Fence�� ❑ Shed ❑ Demolition ❑ Gas ❑ Siding PO . Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2. Parcel ID Number: �, t_I2s ( © 1 6-7 2,6 09 SPECIALTY PERNIIT 3.j Compl@te Description of Project or Work: C 7, es-Eua�e--U vn:� �e Af� JWJ) - ��,It 4. Owners Information 5. Contractors Information Name: LcnA ,Ki -ems rift 4-<— FL Reg/Cert #: CP L lZ �6 Address: ��'j \ ( M "ad I!, City: 2.,eACYState: L Zip: Phone: -7 6 f2 S) &7,g 6. Value of Construction: $ LfUb County Cert#: Business Name: Phone: 7?Z3 (y 4`iS(Fax: 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 construction and zoning. P OWNER OR CONTRACTOR INANE A - SIGNATURE OF OWNER OR C C STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS WHO IS PERSONALLY KNOWN TO ME XOY F 20_L�( BY V6 OR WHO HAS PRODUCED AS IDE ICATION. SIGNATURE OF NOTARY COMMISSION NUMBER DAWN MILOapeai) * .�c: Notary Public - State of Florida t -' • . • My Comm. Expires Mar 22, 2017� Commission # EE 877571 Banded Through National Notary Assn 'BALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED TO MEET THE FLOOD ZONE ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on reverse side of this sheet) Revised 04/17/2014 NOTICE TO OWNER: FAILURE '1`: <;ECORD 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 $7,500.00 INSTRUCTIONS Please complete all information in the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The information.to be provided with this application includes: 1. Location/Site Address ` " Indicate the street address or general location of property where the building activity is taking place. 2. Parcel ID Number Indicate the tax identification number of the property where the building activity is taking place. 3. Description of"Project or Work Activity Fully describes the activity to take place. 4. Owner Information Indicate the name and address of the owner of the property on which activity is taking place. 5. Contractor Information Indicate the State of Florida registration number (if applicable), St. ;Lucie County contractor license number and the name of the business doing the work. 6. Value of Construction Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the building/construction activity. Construction value is used to determine the permit fee. St. Lucie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction. ❑ Gas Attach 2 piping schematics with tank size, location, and BTU of each appliance Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications ❑ HVAC No attachments necessary This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications will be accepted for processing after.430.P.M. For assistance in completing this application, please call (772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. Upon issuance of this permit, required inspections can be scheduled by calling 1-866-284-1280 or logging on to http://codeinspectionpublic.stlucieco.gov/ GILES LANGWORD GtLus Dovc;FoRD 7