HomeMy WebLinkAboutSUBMITTED PAPERSPlanning & Development Services
Building & Code Regulations Division SC�NNFD
2300 Virginia Ave. `SB y
Fort Pierce, FL 34982 t LUcie
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(772)462-1553 Fax 462-1578 �Un f y
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing ❑ HVAC ❑ Fence
, ❑ Shed* ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: i t o 5 qov-LtR. ee A
2. Parcel ID Number: 411 (5 at --5 C)UCU I C)C)oto
3. Complete Description of Project or Work: '�DaCE, -t \\ �nx—
4. Owners Information 5. Contractors Information
Name: `17 ��_�(_ FL Reg/Cert #:
Address:
City:
(10
State:
Zip:
Phone:
C`ria-
6. Value of Construction: $ 5,pq�
County Cert#:
Business Name:
Phone' 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 z . g.
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PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWf4ER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 2)d DAY OF 20, BY
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCEDr 1� �`-� ��J1� • p� ' lQ�° JJ
AS NTIFICATION. min
=tills LASHAHNA INGRAM
MY COMMON I EE 050558
SIGNATtJRE OF NOTARY E OR PRIM N OF NOTARY IL
off: EXPIRES: December 20,2014
�C� Bonded Thru Notary Public Underwriters
COMMISSION NUMBER E& Dsosl %
*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 . vRECORD A NOTICE OF COMMENCEMENT 1�- 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
buiIdirig/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
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❑ HVAC No attachments necessary
This'applicatiorican besubinitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 34982.. All .:etmit �a ' lications must be filled out completely before submission. No applications will be
P PP, - P Y PP
accepted for p' rocessingater 4:30 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://cod'einspectionpublic.stlucieco.gov/
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