HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONPermit #
Planning & Development Services
Building & Code Regulations Division
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: —5�7 7/
2. Parcel ID Number: -,;440-3 — 4, 9 7 (�— e 60 �d
/�f CIS
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description of Project or Work: I
4. Owners Information S. Contractors Information
Name: 1��i177. �i%J FL Reg/Cert #: ER 0000122
Address: —.5-60 3 dzzda,&& 44, • County Cert #: 2098
City: State: Business Name: Law's Electric, Inc.
Zip: �9d a Phone: Phone: 772-971-4512 Fax: 772-878-3347
6. Value of Construction: S
OWNER'sAFFIDAVIT:. 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 regulatip6onstruction and zo :ji;g4
James W. Law
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 2 DAY OF 20 3 BY James W. Law
WHO 1S PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JULIET LAW
ARY AS [DENTIF PUBLIC
TATE OF FLORIDA
Juliet Law (seat)%rl=
omm# EE846906
KiaWURE OF NOTARY TYPE OR PRINT NAME OF NOTARYxplre5 10/28/2Ui 6
COMMISSION NUMBER EE 846906
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