HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due: I3 :l� 6a 1 Recei t# I6 ermit #�30� a0q a
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Planning & Development Services
Building & Code Regulations Division SCANNED
2300 Virginia Ave. B Y
Fort Pierce, FL 34982 St. Lucie County
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical
❑ Plumbing
❑ HVAC
❑ Fence
❑ Shed
'Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty perndis
1. Location/Site Address: q `'N 2 N) cii)ct') R] yd \)cI /, 1t n &nc
2. Parcel ID Number: H 50%=51 11 H9-0()Q —3
Office Use
Only
Section
To
Range
Map Page
Zoning
Land tJse
Initials
3. Complete DescriVtion of Projector Work:
4. Owners Information 5. Contractors Information
Name: Ec Y 1 T_ Eams FL Reg/Cert #:
Address: '133 .L m Ayc County Cert#: 2—?jta J0
City: Q State: C A Business Name: Mt�/�"' �� -�rLd)()n `q
Zip: q2j Phone: hone�� 1 Fax: /_ 7 ZG ��"7V
6. Value of Construction: $ 1, ,goo,
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
colgplian applicable laws regulating construction and zon'
PRINT OWNEROR CONTRACTOR NAME ` SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
O i DAY OF 20 BY��
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
DFICA ION. , •�::e!'.,, DAVID N. KNEPPER
` = Commission #ADD 995518
Expirtptember 25, 2014
SIG 'URE OF 0TARY TYPE OR PRINT NAME OF NOTARY ' ;� ;;;'`�- Bonded Th.Tmy Fain Ins ..80038r7010
COMMISSION NUMBER
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
't.
Planning & Developmk6 ent Seivs ASBESTOS NOTICE
Buiid(ng & Code Regulatign Division
2300 Wginia Avenue,
Fort Pierce, FC.. 349k
Phone:",, 462-2172. Fait &h)462-6943
Asbestos Notice to Contractor
September 09, 2013
MEL-RY CONSTRUCTION
MACK MATOS
10967 S OCEAN DR
JENSEN BEACH, FL 34957
RE: Building Permit Number 1309-0092
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notify the Department
of Environmental Protection of any intentions to remove asbestos when applicable in accordance with state and federal
law.
gnature
Date
9/9/2013 2:26:35 PM