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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: Fee Dut. I Recei t#" VU I -D - r - Permit # St. Lucie County Building & Zoning 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 All Ol-1 Tel. 561-462-1553 SPECIALTY PERMT APPLICATION s C st � e�NFa Electrical ❑ Plumbing ❑ HVAC ❑ Fence 40/6 c Shed ❑ Demolition ❑ Gas ❑ Siding °�nty Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2. Parcel ID Number: �J i I kcc�-+ Coves , (,,ZOr 0034, —oov-3 Office Use Only Section Townshi Range Map Page Zoning Land Use Initials 2— (0 3 S z4 0 C 3. Description of Project or Work Activity: / r)� d-(—' 4. Owners Information 5. Contractors Information Name: �� '� t� aK-21 /A1 a.lrce/10 FL Reg/Cert M g C / 3 0 0 Z g SD Address: 9 C o 0 IL .P C( Gz— County Cert#: C; 3 b ,. 3 City: �1 c UJh State: Doi Business Name: r%Z �Gec Svcs Zn C Zip: 0 7% Phone: Phone 3 `f 0 d" Fax 3 L/0— 76 71 6. Value of Construction: $ C� d 0r © o 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 zo g. !. J0.Mil I U✓Lfi(�erwook PRINT QUALIFIERS/OWNERS NAME , ' SIG RE E THIF QUALIFIER/OWNER STATE OF FLORIDA, COUNTY OF 4. L lam at-& ACKNOWLEDGED BEFORE MS i/ O DAY OF 20B, BY" I V Rdle "b O IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION. ` (ce) SIGN6yM OF NOTARV TYPE OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC St. Lucie County Specialty Permit Application rev. 8/25/05 drug COMMISSION NUMBER SYLVIA LOMBARD02M MY COMMISSION # EE 140761i {� Bonded Thru Notary PubUc Underwriters