HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONr'IDate Fee Due: q 4 I Receipt# 11ermit#
Planning & Development. Services _
Building & Code Regulations Division
2300 Virginia Ave. 13 Y
Fort Pierce, FL 34982 51, ( UCIQ
(772)462-1553 COUMy
SPECIALTY PERMIT APPLICATION
® Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number: 3414-501-1701-000/9/
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 Bldg. Corp
Address: 8000 S US # I
City: PSL State: FL
Zip: 34952 Phone: 878-5513
6. Value of Construction: $ l ff Q 0, Q r
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 ttnpplication is correct and that all work will be done in
compliance with all applicable laws regulating uction and zo ing
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 0��20 Z__3, BY James W. Law
WHO IS PERSONALLY KNOWN TO ME X OR WHO HAS PRODUCED JULIE-T LAW
TARY PUBLIC
AS IDENTIFICATIO . MGM X STATE 151 FLORIDA
Juliet Law (seal) Comm#EES46906
SI RE OF NOTARY TYPE OR PRINT NAME OF NOTARY EIres W28/201 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