HomeMy WebLinkAboutSUBMITTED PAPERSpats: Fee tAue� ` Receipt# ; _ Permit #
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Plann' ing & Development $erviim
Building & Code �e lations Division
2300 Viigllt,4a Ave
Fort Pierce, FL 34982 SAC
(712)462-1533 Fax 462-1578
SPECIALTYPEA' APPLICAUON o
Uhty
E3 Electrical E3 Pl ' ing ❑ HV ABC 13 Vence
0 Shed* emolition 0 Gas 0 Siding
See pW 2for itlsftvc iv&y surd oddddoval paperrYork req*ired for specfalffp0Wd&
t. LocationJSite Address:
2. Parcel ID Number.- `I S) .� - (� �.
3. Compie a Desedptlon of Project or Work: �' —e' als y>- j c
4. Owners leformation 5. Coutractvrs Information
Neme: (�� � �, h o w� 17a°��,rl M )Fleg/Cert 0:
� z,
AKdd�ress: � � �) � �i � �j� 'S `� � Couldy Ceres
City,: State:
Zip:
Phone.-
��
6. Value of Construction: $ _ 2 r:I�F &C7
Rudoess Name:
Phone:i� Fax: Z M ti 7
QvIln is AFFEDAVrr: I ccrtily that all of the InfoMadon contained in this application is correct and that all wodc will be done in
compliance with all applicable I&WS regulating cons4wWoa and zoning.
FRU4T OVINER 0A CONTRACT'OR NAME j 2XAW�UOFWiVZR CONIRtiC1OR
STATE OF I;WPMA, COUP T OF J ► Iv �ACSL' �`
ACM0WLMGM)3aORT3 ME Tills �- PAY OF r+ A I _ 9 2OLt BY
WHO IS P )B4
YTOW Olt WHO HAS PROD MU
I
j►� i DAVt[)IPPt
SIGI�IATUILE NOTARY IcR PRJNI NAIYIE 01F NOTARY :i% Camrr� ;<l+DD 995518
Expires September 25.2014
COlYtivI15510NNi]MSER . ,.._,._. .
• eoatm„tr�yfamuyirano�aaoaeatmo
'BALL REsIDE►Ix',TAL AND NONRESMENiIAL smucru S ARE REQURIEU To MEErTfiE n'001)ZONE
ELtVATION OR 18INCHES AJ10N)C, TBE CROWN OF TO ROAD, WHICHEVER IS,AITLICABLE. (see i"st ucdons on
reverse side of this sheet)
Revised 031199014
Fee Due: , = � l "'5l I Receipt# % I VW ' I Permit #
M
®_ Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
r w (772)462-1553 Fax 462-1578
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Pluabing ❑ nvAC ❑ Fence
❑ Shed* emolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional papenvork required for specialty permits
1. Location/Site Address: / C9 Z 6 1 S T < v- J �L53 G� 31 K
2. Parcel ID Number: `1 IS) I _ —'Z, 1 <2�> C-2 0 �3 L — d VZ9— /
3. Complete Description of Project or Work: e C-- Z �) �� a t
4. Owners I`nform1ation ` 5. Contractors Information
Name: C I �V C� �� ��, ih 9 W �'� 0I n FL Reg/Cert #: �^ C/
Address: ;?loo /L �-� Z&70County Cert#: Z�
City: State: Business Name:
Zip: Phone: J C2� Phone::i �?t �Fax:
6. Value of Construction: $ f 6 &C2
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 zoning.
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF WNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF S. f �� Ile —
ACKNOWLEDGED om; ,'C
BEFORE ME THIS � DAY OF 3" V)Q 201, BY 1 I�C%� , , m�+ J W
WHO IS PER N LY OWN TO ME OR WHO HAS PRODUCED
AS IDENTItTIO Ow
SIGNATURE OTNOTARY
COMMISSION NUMBER
(seal)
TYTEORPRINTNAME OF NOTARY
`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 03/18/2014
��v«iPi `i0v±�t
Planning &;Development Services
Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL. 34882
Phone:(772)462-2172 Fax:(772)462.6443
June 02, 2014
MEL-RY CONSTRUCTION
MACK MATOS
10967 S OCEAN DR
JENSEN BEACH, FL 34957
ASBESTOS NOTICE
Asbestos Notice to Contractor
RE: Building Permit Number 1406-0030
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notify the Department
of Environmental Protection of any intentions to remove asbestos when applicable in accordance with state and federal
law.
/d• ",
Signat
Date
6/2/2014 2:36:41 PM