HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: "1 ,3 JFee Due: . 6 0 1 Receipt# 19 0 l l' _; Permit # 1Oa(n
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982 SC,q
(772)462-1553 St a ��ED
C C/C
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: 41PIk
2. Parcel ID Number:.P Z b .2 ^ D (PI f O O Q I S/
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: ( p I Iq C c_ C2i t4- I E- PL�--
�e1 (' + N- t.9 C_
4. Owners Information 5. Contractors Information
Name: F ,--,z FL Reg/Cert (a 9�3
Address: `/® ( � 0 r r-t yxJ 0 0 L9 C County Cert#:
City: Pr J,&C ti State: Business Name: C ?'S 19 I tits'
' �l�0?7i
Zip: 3 <%� Phone: �.
'�� -� `-�S' S Phone: �/ (0 6 7? � `� Fax: �_
6. Value of Construction: $
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 1 }� DAY OF `•� 20 l , BY V 'r T
WHO IS PERSONALLY KNOWN TO ME OR WH S PRODUCE 41p S 3 3 "• 1 1 5 °�' O S-1 "'
MANNA GIVENS
P
AS IDENTIFICATION. ,,,��t,,,
�Y �%�•,, Notary Public - State of Florida
ti. V�d► 1 V -4k. V\ ' _* ; . My Comrris"Dires Dec 16.2016
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOT AR ? a oec Commission # EE 858761
r� Bonded Through National Notary Assn.
COMMISSION NUMBER
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
,� OiICE TO OR'NER: FAIL:,,.---- TO RECO6:' k; OTICE OF COMMENCEME� --,."Ay 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 $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
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 describe the activity to take place.
44. 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
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
similaitypes 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, Z 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
❑ HVA C Attach 2 residential energy studies, 2 manual J caleulations. 2 sets of duct layouts for
J
` new systeni or full replacement r
This,appl catioii can -be -submitted to St. Lucie bounty Building and Zoning, 2300 Virginia Avenue, Fort Pierce,
FL 3498�i<�; E l�,permi*fi applications must be filled out completely before submission. No applications will be
accelWd far processor �a to 4�. 30 I':1dL: For assistance its completing this application,:.please;,ca)1(772)
.462 T55'3,"du`ring re fice hours (8:00 AM - 5:00 PM), Monday through Friday.
Ica,. F.-.(+iw.l_.l•.°a� i'"
NOTE: Emergency lectric 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.