HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
Fee Due:
COUNTY
F L O R I D A
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing
❑ Shed ❑ Demolition
(/HVAC ❑ Fence
❑ Gas ❑ Siding
See page 2 for instructions and additional pgperwork required for specialty permits
1. Location/SiteAddress: Y� Z.5- -I�Mxd Siilz)
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2. Parcel ID Number: JYZ2- ,SOa? ' OD/S %DD "
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I Complete Description of Project or Work: L /l-r C- 7-,/-
4. Owners Information �° / 5. Contractors Information
Name: Ae lkad d&l� ZLd, -1 l , FL Reg/Cert #: C J1 C D $ l81 0
Address: 9T�.S %��� / County Cert#: �t Q71 b
city: State: TL Business Name: NjTeM A l r gssavns bN C
Zip: 3411b Phone: ��0� /�ig Phone: 17a 335 3-13a Fag: 77A 335. 14 b8'
6. Value of Construction: $ 7310'7
OWNER'S AFMAVrr: I certify that all of the information contained in this application is correct and at all work will be done in
compliance with all applicable laws regulating constructin;r�
i
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PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF 0 OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF ST L u ea
ACKNOWLEDGED BEFORE ME THIS Af DAY OF �r� .201� • BY
WHO IS PERSONALLY KNOWN TOME V1 OR WHO HAS PRODUCED —
O,�p,PY Pueli CHRIS11NE B. ENGLISH
AS IDCATION. j-///'/� � lMY COMMISSION # EE 859284
_ �) EXPIRES: April 4, 2017
MONA�OFOTARY / TYPE OR PRINT NAME OF NOT �"'IOF F O" Bonded Thru Budget Notary Services
coWSSIONNUMBER G �" `� ?y
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 WrM YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500.00
Revised 04/26/2010