HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONi
Date:LNee Due: Receipt# E Wmit # Sx AD �)c
Planning & Development Services
Building & Code Regulations Division `�CAIVIV,
2300 Virginia Ave.
Fort Pierce, FL 34982' �CICf@
(772)462-1553 C�C�001
SPECIALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed Q Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: I? cz.A-
2. Parcel ID Number:. 3414-501-1701-000/9 W-/
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
3. Complete Description' of Projector work Activity: Replace meter center with a combo pack
4. Owners Information
Name: Wynne BldAr. Corp
Address: 8000 S US # I
City: PSL State: FL
Zip: 34952 Phone: 878-5513
6. Value of Construction: $ / �[�(�i ) e2
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 regulati construction d oni
pp
James W. Law �
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS, DAY OF - 20 BY James W. Law
JULIET LAW
WHO IS PERSONALLY K TO ME X OR' WHO HAS PRODUCED TARO PUBLIC
AS I NTI TIO STATE CIF UBLICFLORIDA
Juliet Law (Seal) WE)Vres
Comm# EE846906
SIG OF NOTARY TYPE OR PRINT NAME OF NOTARY 10/28/2016
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 04/26/2020