HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONRate:
SCANNEDO
BY
St. Lucie County
® ElectricaI
❑ Sbed
Fee Due: Recei t# I Permit #
St. Lucie County Building & Zoning
2300 Virginia Avenue FL Pierce, FL 34982-5652
Tel. 462-1553
SPECIALTY PERMIT APPLICATION
❑ Plumbing ❑ HVAC ❑ Fence
C7 Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specWty permits
I, Location/Site Address: 4C,� 2 S ijea a c ca n a_i 42_ Q d .
2. Parcel 10DNumber: 3 (.0 — �)a i 000 1 — Q() � r
Office Use
Only
Section
Township
Range
Map page
I Zoning
Land U e
Initials
�
3. Description of Project or' Work Activity. P,
t-h n -t- w VP r -P c -%--n 1-P r
4. Owners Information
Name: 'LFf-��6 rok gfS I %,.0
Addlress: P(D b O x q Q 19
-eill V1\/1 r
5. Contractors Information
FL Keg/Cent
County Cert#:
r
I.t4Z• fi�YF'
City: V Stater, Business Name:
Zip: �.Q ILO .a.-- Phone: -1 � 2-1-13 ' i ones - a ax z) - 2-4 1
1 t0�1l1
6. Value of Construction: S 2310
OWNER'S AFFmA,VTt: I certify that all of the into oration contained in this application is correct and that all work will be done
in compliance with all applicable laws regulating construction and zoning.
.-GodL-e—tt-8LLls�r. —
PRINT QUALIFIERSn1WNBR$ NAME
SIGNATURE OF QUALIFIERIOWNER
STATE. OF rL0R1DA, COUNTY OF l &L_P—%JJC
J ACKNOWLEDGED BEFORE ME THIS _ DAY OF
'Q,ld.t-- 201 , BY 6!&� i9d Ld M -7 W140 IS PERSONALLY KNOWN TO ME OR WI-IO I4AS PRODUCED
AS IDENTIFICATION.
(Von()
SIGNATU • QP NOTARY TYP OR PRINT NAME OF NOTARY
TITL NOTARY_ UB1 C0MMiS510N NUMBER
CYNTHIAS,WELFORD
ee; MY COMMISSION# EE OHMG
` EXPIRES: June 17, 9015
St, Lucie County SpeCiolry Permit Application rev. 8/25f05 dmg ' ,p� I , ` Banded ri,rit Notary P6110 Undewlters