HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION,f ' Date: $ l 3 Fee Due: (3 Receipt# of f':rmit # 130 C1p1 5
Planning & Development Services
J _ Building & Code Regulations Division
p 2300 Virginia Ave.
. Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical ['Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number:
7691
3ai-
JtN w,
- 00L13 - 000-
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: 50 6 EI +e.C4yy L walze �e cx�,
4. Owners Information _ 5. Contractors Information
Name: DamC1 10rfe-S FL Reg/Cert #: (;EC r'YaSG�-J%
Address: 769 [ C11Q �e00h V) County Cert#:
PIMA
City: YOO SJ 61 State: f L Business Name: RkZ )uy-A(J►v)B LLC
Zip: pq O jo Phone:790 O —0 ® Phone q%85"1-6590 Fax: Q5'/ 677 95%
6. Value of Construction: $ 6 l b
OWNERS AFFIDAVIT: I certify that all of the information contained in th' application is correct and that all work Will be done in
,^ c mpliance with all applicable laws re;STGNATURESOFOWNE5ROR7
ati ntructionZoning.
PRINT OWNER OR CONTRACTOR NAME)� CONTRACTOR
STATE OF FLORMA, COUNTY OF �L%.c(A
ACKNOWLEDGED BEFORE ME THIS --DAYOF T1SIG S� 20 12) BY R)IqQ.l K)L
WHO IS PERSONALLY KNOWN TO ME/ OR WHO HAS PRODUCED
AS IDENTIFICATION. pgYp�e ; Radina Stoyanova
a.' n eCOMMISSION#EE837091
SIGNATURE OF NOT TYPE OR PRINT NAME OTARY SEP 20, 2016
C�, Q'Q NNJNI.AARONNOTARY.com
COMMISSION NUMBER L Cy 0 1 I
NOTICE TO:OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TVITCE 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
NOTICE TO OWNER: FAILURE TO R; RD A NOTICE OF COMMENCEMENT MAY R !.T IN YOUR PAYING TWICE FOR
IMPROVEMEN`.2. -:`3 YOUR PROPERTY. IF YOU INTEND TO 6,r ;IN 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 Number
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
❑ Siding Attach 2 copies of manufactures specifications
❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement
This application can be 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.