HomeMy WebLinkAboutSUBMITTED PAPERSPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing HVAC ❑Fence
L7 Shed ❑ Demolition 0 Gas ❑ Siding
See page .
1. Location/Site Address:
2. Parcel ID Number:
paperwork required for specialty permits
/� s nishLoki��� �
Office Use
Only
SectFon
Township
Range
Map Page
Zoning
Land Use
3. Com fete Description of Project or Work: `% 5 "J LAM a- e SLc S' '3?3'C, 9 i C9 (,Zl ,, Z /��`
4. Owners Info ation 5. Contractors Information CfiC / 91'73 ��
Name: l� Q FL Reg/Cert #:
Address: S County Cert#: g
City: r (e/ c�tate: l - Business Name: fiAbfAK.— l 6� I Lok
Zip: 3- l I Phone: �o J Phone• �Max: J
6. Value of Construction: $ �3R O Vof=
OWNER'S AFFIDAVIT: )certify that all of the information contained in tlii a(splication is correct and1hat all work will be done in
compliance with all applicable laws regulating struction and zoning.
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _' - OF
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
COMMISSION NUMBER
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
Revised 04/2612010
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY
FILE $ 3962288 OR BOCK 'Ni39 PAGE 968, Recorded 06/06/2014 a� j:52 AM
NOTICE OF COMMENCEMENT
pink No. I LID •Tax Follo No. 141 k Io Of - .O 10 - O 00
State of Florida County of St. Wde
The undersigned hereby Om notice that improvement wIB be made to certain real property,.and in accordance with Chapter 713, Florida Statutes,
the following Information Is provided In this Notice of Commencement
Legal Description of Property: (and street address Iavalable): 3301 R�i • , F4. P: vrs., L
lA_'.a II Ax L3 Lai- L.a.ee 4,11. RIB
Genereldes ripilonofLnprovertwrlt Ate: L4��yr Ca.�r..it5l� u,G eLcr % LY jctt' N� poi+-.r
owner 6
Name
Address
information I the Lasses contracted for the improvement,.
Irderestlnproperty:
Name and address of fee simple titleholder (if dlffetentfrom Owner listed above):
tantracwt Name
ContractorAddrass S21 o FL 3 Y4 4 % Phone Number. ,(-7*7 %) -f O!Z Ti L
Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $
Name and address: Phone number.
LerderNamr. Phone Number.
Lender's address:
Parsons within the Stab of Horide dolprbd by Owner upon when rrotioes ar othw dom manta nay be awed u provided bysaetlon
I39 1) (a)7. HoNs Stotnbs:
Name: Phone Number.
Address:
In addition to himself or herself, Omer deslyates of to receive a copy of the
pence's Notice M provided In Section Zl;<, 1) (b), Florida Statutes.
Phone numberof person or entity desigated by owner.
Expiration date of notice of commereemeM: (the exphatlon date may not be before the completion of construction and final payment to the
o ntrac r, but will be 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OFTHE NOTICE OF00MMENCEMENTARECONSIDERED
IMPROPER PAYMENTS UNDER GIAPTER 713, PART I, SECTION 713.19, FIORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTSTO YOUR PROPERTY. A NOTICE OF COMIIENCOADIT MUST BE RECORDED AND POSTED ON THE 1CB SITE BEFORE THE FIRST
INSPECTION. IFYOU IN71END TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of peoury, I declare rt I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my I awledge and
1
771
(SlgraWmofownera Lessee,or esorLesmesAuthorizedOfRoer/DlrKWr/Partner/Manager
(Sip aws TRWOlice)
The Ing instrument admowledged before ma this_ of 11 AO. 20 J/``
By Name or as Type of authority (e g. a icer, tnrstee) Party no half of whom instrument was executed
• TIFFANY 8. XON
NOTARY WaLw krawn Produced Identification_.
(Stpathae Publ - State of Flodda) STATE OF I
MMgp
(Print,Type, Ste Commissioned Nona of Notary Public) �demificatlon produced
NNW E7OYM M120/6
STATE OF FLORIDA
ST. LIXIE COUNTY
TFII S IS TO C RTIFY THAT Tl{IS IE a
TRUEAND RRECTCOPYOFTH
ORIGINA .
JOS P �11TH ERK
W y
Date: