HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: 13 Fee Due: a Receipt# 3g7q permit # 130I -0O9 5 �.
Planning & Development Services
Building & Code Regulations Division qq
2300 Virginia Ave. 1V
Fort (7 Pierce, FL 1553 982 at j 110
/
County
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:
2. Parcel ID Number: 3414-501-1701-000/9 All
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Projector work Activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 8000 S US # I
City: PSL State: FL
Zip: 34952 Phone: 878-5513
6. Value of Construction: $ / E Co. 00
S. Contractors Information
FL Reg/Cert # ER 0000122
County Cert # 2098
Business Name: Law's Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
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 regulatin o struction and zoning
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 BY James W. Law
JULIET LAW
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED TARY PUBLIC
A IDENTIFI STATE OF FLORIDA
Juliet Law (Seal) Conml# EE846906
SIGN54URE OF NOTARY TYPE OR PRINT NAME OF NOTARY EVf BS 10/28/2016
COMMISSION NUMBER EE 846906
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 04/26/2010