HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONt
Fee Due;_ I Receip M Permit #
13U9
Planning & Development Services
Building & Code Regulations Division SCq YNEE
2300 Virginia Ave. B
Fort Pierce, FL 34982 St. LUCI@
(772)462-1553 COUnty
SPECIALTY PERMIT APPLICATION
® Electrical 1 ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed F-1 Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
/0, /-2 w- / LI
2. Parcel ID Number: 3414-f6-1-1701 000/f
Office Use
Only ;
Section
Township
Range
Map Page
Zoning
Land Use
Initials
S. Complete Description' of Projector Work Activity: Replace meter center with a combo pack at each address
4. Owners Information
Name: Wynne Bldg. Corp
Address: 8000 S US # I
City: PSL State: FL
Zip: 34952 Phonn'eQ878-5513
6. Value of Construction: $ l vO
S. Contractors Information
FL Reg/Cert # ER 0000122
County Cert # 2098
Business Name: Law's Electric, Inc.
Phone: 772-971-4512 Fax: 772-878-3347
OWNER'S AFFIDAVIT: 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 regulatonstruction and zoning p
James W. Law
PRINT OWNER OR CONTRACTOR NAME
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS _! DAY OF
SIGNATURE OF OWNER OR CONTRACTOR
20 ZZ . BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED AMA JUUET LAW
F
TARY PUBLIC
A IDENTIFI e ATE OF
Juliet Law (Seat) .ATE EEYA6 FLORIDARI
OF NOTARY TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER EE 846906 06
moires 10/2M2016
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