HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONPlanning & Development Services
Building &: Code Regulations Division
• 2300 Virginia Ave..
+ R I D A- Fort Pierce, FL 34982
(772)4624553
SPECIALTY PERMIT APPLICATION
❑ Electrical. ❑ Plnmbing. k]E[VAC ❑ Fence
❑ Shed U Demolition [ Gas ❑ Siding
Seepage 2 for kis>r edons and additional paperwork required forspecial& permits
1. Location/Site Address: 31
.
2. Parcel ID Number• c�DS- (ao
Office use
Only
Secdbn
Townslup
Range
I MV Page
Zoning
Land Use
Initials
3. C mplete'Description of Project or Work:
A Owners Information- 5. Contractors Information /� n
FL Reg/Cert #: l ✓`1C isS 13 & a
Name: q
County Cert#: 11C:91 L( < D �
Business Name:
Phone: `l(s - (�f a �j �Faae GICe �� -l/oZ `7
A'
Address: ���.... a Li:. •. c .� .
City: �� ct State:
Zip: J L(07 C: Phone:
6. Value of Construction: S L�
OwN ER,s AFFIDAvIT: • I certify that all of the information contained mi this application is correct and thgN!=Jd�2
compliance with all applicable laws regulating con coon and zoning. ;j R EE 050558ber20,2014blic Underwriters
PRINT ORCONTRAGTORNAIu1El SI A OF O TR
R OR CONTRACTOR
ACTOR
OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE IME THIS DAY OF 20 14 , BY �'�" v
WHO IS PERSONALLY KNOWN TOME `OR WHO HAS PRODUCED - � 6 w L i 71
�L Sd'ti� 3-1�-o ST'I_UC TyBOARD �-.
ENTMCATtort. OFCOUN 1SSIQNERS
& Z 2415
TURBOFNOTARY - OR PRINT NAM OFNO ARY 000050999392
COMIIIIISSIONNUNBER ' 0S6_<! D
NOTICE TO OWNER: -FAILURE -To RECORD A ,NOTICE OF CONMENCEMENT MAY RESULT IN. YOUR PAYING TWICE FOR
INIPROVon. ft. 5 TO YOUR PROPERTY. TF YOU INTEND TQ OBTAIN Fll�iiANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF-COM ENCLMVff.
EXEMPT: AW-HEAT REPLACEMENT WITH CONTRACT UNDER $5,000.