HomeMy WebLinkAboutSPECILATY PERMIT APPLICATIONJun 03 2013 10:30 HP FaxFl Delta 95 >=9018�. page 2 -
St. Lucie County Building & Zoning
2300 Virginia Avenue Fi. Pierce. FL 34982-5652
TeL 561-462-1553 is
SPECIALTY PERMIT APPLICATION
❑ Electrical Plumbing ❑ HVAC ❑ Fence 0%
❑ Shed Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for svecialty permits
L Location/Site Addn
2. Parcel ID Number:
Office Use
Only
Section
I Township
Range
I R Page
zonine
Land Use
Initials
3. Description of Project or Work Activity:
4. LmnersArpormatio S. Contractors Infor tion
Name: % FL Reg/Cert #: c� i"
Address: t
f l County Cert#: �
City: State: ( Business Name:
Zip: S Phone., _. � ! Phone
6. Value of Construction: S
OwNER's AFFIDAVIT: I certify that all of the information contained in this
compliance with a applicable laws regulating consi
njy V
PRINT QUALIFIERSIOWNERS NAME I ; , /_ , S7
s
!' EWA 11
N � �.
is correct and t>>At*ll work will be done
OF
ME THIS -,:S _DAY
BY / 1. IIC,/ 4eeQr V HQ IS PERSONAiLL I IOwN T9 ORDwHO HAS
AS 1DBN ATION.
URE OF NOTARY T081OR PRINT NAME OF NOTARY CJ/
NOTARY PLr9LiG
St. Lucie County Specialty Permit Application rev. 8125105 duq
COMMISSION NUMBER