HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
i
Due:
MMMM
roofs
SCANNED
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave..
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
BY SPECIALTY PERMIT APPLICATION
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St; !_-laic County Electrical ❑ Plumbing ❑ HVAC ❑ Fence lv&l-�671
❑ Shed* ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork
�/required for specialty permits ¢� /
1. Location/Site Address: �(�(� l nFf.�W J ( %',,AL �� 1 v ���t^'" `�-u
2. Parcel ID Number: 3,22 / —2 Z a -00 b/ — ono ,
3. Complete Description of Project or Work:
o- & Fiu I Lb 6 �-
-FM46L
4. Owners Information 5. Contractors Information
Name: %-�11i ( ,12�'�tl/ % FL Reg/Cert #:
Address: 71,60 (2i� County Cert#: �t' '300 % ZZ
City: JWs &LICt fG State' /' Business Name: &'/a - Lt/'
Zip: 3 Y g S -� Phone: �b t� Zia 716 % Phone: l%L 337- ri4 % Fax: T Z Z -
6. Value of Construction: $ /bra' be
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 construun and zoning
ClC/w(�-
OWNER OR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
AS ID =1FICATION.
SIG OF NOTARY
COMMISSION NUMBER
, III , DAWN MILONE
),Gw (� 11 - Notary Public - (%tao of Florida
TYPE RINTNAME OFNOT _, 4F * My Comm. Expires Mar 22, 2017
Commission # EE 877571
01
Bonded Through National Notary Assn.
*ALL 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 T(, A+CORD A NOTICE OF COMMENCEMENT MA-_ �?�SULT 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
2. Parcel ID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
6. Value of Construction
Indicate the street address or general location of
property where the building activity is taking place.
Indicate the tax identification number of the
property where the building activity is taking place.
Fully describes the activity to take place.
Indicate the name and address of the owner of the
property on which activity is taking place.
Indicate the State of Florida registration number (if
applicable), St. Lucie County, contractor license
number and the name of the business doing the
work.
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
builciing/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 itis 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..A11 permit.applications must be filled out completely before submission. No applications will be
accepted for processing after 4:30 P.M. For assistance in completing this application, please call (772)
462-1553, during -re' Nr 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/