HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate: b V 3 Fee Due: 1-S6� 0 Recei t# cl 15 5 1 1 Permit # 3 CA - 0
Planning & Development Services
-:Y Building & Code Regulations Division
2300 Virginia Ave. S Cq /V/VEFO
Fort Pierce, FL 34982 8 y
_- (772)462-1553 � U
Cour7ty
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence.
❑ Shed fi5 Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialtypermits
1. Location/Site Address: 7 Z �S�: W Ay
2. Parcel ID Number: Z 3 0 ? - & o 00 — 3
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: Lela G]- OF D `b )1V n 4. �qwo
G0A)CkS-72F
4. Owners Information 5. Contractors Information
Name•�gmfS,LErEGn/�iL FLReg/Cert#: li%ZG /,�3 D �s
Address: IN 0Co t0f V Vistr/� /1� County Cert#: 2J6PO
City State: f �- Business Name: 6AS9-L-e 72—DA)
—ZAIC
Zip:-Fgfl?1 Phone: 7? Z Z01 Id3,3Phone: 772 Zd/ W.Z?Fax:
6. Value of Construction: S /.500.. 00
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
co liani:e with all applicable laws regulating construction and zoning.
�/w O" ORCONVAMORNAME SIGNAT OF OWNER OR CO ; CTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS !S+)b# DAY OF S %t k . . 20 L3 . BY A VVA-b -Tf e."C % 5
WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED ��+ �D l.• y 13 ' a� �' —
AS IDENTIFICATION. nY CPU (• DEANNA GIVENS
.�o;P a �., Notary Public - State of Florida0c
Q �q n yr a 6- 1 �/ _ ' ` omm. Expires D �l�f; ?,
SIGNATURE OF NOTARYTYPE OR PRINT NAME OF r o;, Commission # EE�aO/ st
Bonded Through National Notary Assr s
COMMISSIONNUMBERL•��$�
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
NOTICE TO OWNER: FAILURE TO RECORD, ANOTICE OF COMMENCEMENTMAY RESULT IN YOUR PAYING TWICE FOR
MR1. MENTS TO, YOUR PROPERTY. IF YOU ZM19 " ` TO OBTAIN FINANCING, CONSULT WITH
YOU, , • _ - - VDER OR AN ATTORNEY BEFORE RECORDING, JR NOTICE OF CONIMENCEM ENT.
EXEMPT: A/C -HEAT REPLACEMENT wrrH CONTRACT UNDER s5oo.
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 structuIal -
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
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.bn 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'figuies 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 offence
❑ 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, FortPierce,
FL 34982:-All, "er'iri' - ;
:t ��,i}a applications must';be filled out completely before submission. No applications will be
accepted.for�processiug,'after;4:30 P:M..For assistance in completing this application, please -call (772)
462-155'K"d' ilh'ig regular office; hours;(8:00 AM - 5.06 PM), Monday through Friday. `
NOTE: Emergency `electric service chatzge 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.