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HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONPlanning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 . . SPECIALTY PERMIT APPLICATION • Electrical ❑ Plumbing ❑ RVAC ❑ Fence ❑ Shed- ❑ Demolition ❑ Gas ❑ Siding See page 3 for insttrracdons and additional papenvork required for specialty permits 1_ 'Location/Site Address: 5 ! Q m Pr 2. ParceI ID Number: 37 J,97' 16/ iQI ° Q 3 �3. 000 1 S SCSy �Eb t � Llcip COW7 01 •; ; itC' ;':' Only Section Toi nship Range INlapPage Zoning Land Use Initials :ho 3. Complete Description of Pro ect o1 4. W,-�t �er h ea e r Owners lnfontion 5. Contractors Information J JQ er Name: i�� 1 fir` �Q / f Address: ✓ 79 I a (yt D' ' Citv: 6�/ / erC& State: F1 Zip: 3089 Phone: (6 o• 76?/ 6 d0 6. Value of Construction: S `J6. FL Reg/Cent r: CFC 058oa5 County Cent;#: ! 739 Business Name: POr� S- Lue�e 1 1u y pG [�( 105� `I Fax: i 8 5+ g 1 Z b J Phone: OW?qER'S AFFiD-&viT. 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 regulatirigAonstruction and zoni Ca r w , ZCl ne 110 PRINT OWNER OR CONTRACTOR NAME IGI�° WE/FV-N'"ENR CONTRACTOR STATE OF FLORIDA, COUNTY OF & LuC I C" � - f `( (�fh DAYOF II( .013 _Bi` VV.� Uv• LGt 1l© ACKNOWLEDGED BEFORE ME THIS -2--� WHO IS PERSONALLY Ki�TOVIRV TO iv1E w OR WHO HAS PRO UCED `�''4-- Danielle Biglin ,..., e'o ?z :COMMISSION HE107315 AS ID FICATION.�e`; EXPIRES: AUG. 25, 2015 Dn 0 1 � l Ie { `y;;°,`(sA�yW.AARONNOTARY,cort1 SIGNATURE OF NOTARY /�j TYPE OR PRINT NAME OFNOTARY" COIvIAAISSIONNU `BER CC 1 O 73 `+/ NOTICE TO OR'NER: FAILURE TO RECORD A NOTICE OF COMINKENCEMEN'T tiLaY RESULT IN YOUR PAYING -M'ICE FOR hvIPI20«VIEN1rS TO'YOUR PROPERTY_ IF YOU INTEND TO OBTAIN FINANCLN`G, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDINGYOUR NOTICE Or CONINIENCEMEN'T. E?LE1vIPT_ A/C -HEAT REPLACEMENT NVITH CONTRACT UNDER S7500.00 Revised 04P-62010