HomeMy WebLinkAboutSUBMITTED PAPERSDate: J ee Due: 1 Receipt# Mit #
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC--E�k'ence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: J- /G4- /�Gi� -%y z-
2. Parcel ID Number:
SC 8 YVEG
Lcac/E? CoUnty
Qf"TC2 Use
Only
Section
Township
Range
Map Page
V%Pning,
L d Use
itials
3. Complete Description of Project or Work: 3y I -a' %e-h ce
r / /-ii S.4 Gv'JGoI ?" CA,-- � -76 " Td� AZ (— /U .:4:7.
4. Owners Information 5. Contractors Information
Name: Me-C4 a-,-/ A C 6: x FL Reg/Cert #:
Address: T �Gy' C `� �r' County Cert#:
City: / Y'� Piet-e-e State: /J � Business Name:
Zip: �l � - Phone: `77,x- 861-7116% Phone:
6. Value of Construction: $
06
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 OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF S &V c, . er
ACKNOWLEDGED BEFORE ME THIS DAY OF , 20 13 , BY
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCE
AS IDENTIFICATION.
LI—GN—:1TUREN TARY TYPE OR RINT AME OF NOTARY A
COMMISSION NUMBER eond�Thy �aryP�N�153p
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR P to F
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
NOTICE TO OWNER: FE.. � ;LE TO RECORD A NOTICE OF COMMENCEME':_. '.ZAY RESULT IN YOUR PAYING TWICE FORf
I1V_1-,I 'VEMENTS TO YOUR PROPERTY. IF' YOU IN'L,t) TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000.
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 Dumber
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 describe 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
building/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
EJ Siding Attach 2 copies of manufactures specifications
0 HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
' new system or full replacement
This application can b6 submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 34982. All 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 regular office hours (8:00 AM 5:00 PM), Monday through Friday.
NOTE: Emergency electric service change out inspections will not be performed after 3: 00 PM without
special arrangements and additional fee paid.
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.
0-<w
can erected be W
within any e8sery
right of way Unless o" or, thfi
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Applicant Inklais Se approved.
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