HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONSafe Step South;— -. p,4
Planning & Development Services
Building & Code Regulations Division
. 2300 Virginia Ave.
Fort Pierce
, FL 34982 Sc
(772)462-1553 St C gYNFd
SPECIALTY PERMIT APPLICATION ucie County
JILElectrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for speciahy permits
1. LocationlSite Address: 1 R t l 0 i T i ercic F- 3L(C f-k 9
2. Parcel ID Number: i-UI O-t3algs-aCO- (v
Section
Tottinship
Range
MapPagc
Zoning
La Ise
Initials
3. Complete Description of Projector Work:
4. Owners Wormation
5_ Contractors Information
C)0oac-0-90
mJ Na e:
oy ! AC
r
FL ReglCert#:
�G
Address: t4, }>r%A
-14- 1-101
County Cert#:
City: f ! `4-4 c-
State:
Business Name:
! J0rr%G9hLrpnws CIA? to,
dice E 1d4-tn G
Zip:
Phone: —n ::i, t(to 1-
Phone: %'2' 3114Fax:
(4I03kp
Qlf)4
6. Value of Construction: $
OWNER`S AFFIDAtiT: I certify that all of the information contained ffius application i •e and a ceork will be done in
• PF
compLiancc with all applicable laces regulat construction - igi
PRINT OWNIM OR CO\TRACTOR NAME SIGN URE OF OW*IER OR C TOR
STATE OF FLORIDA. COU"TrY OF� _ �p
ACT;'No,,=GED BEFORE ME THIS _ N fDAY" OF L C L _, 20 13 • BY —365"-. q2!n r • �
WHOIS PERSONALLY KNOWN TO MC�6 OR WHO HAS PRODUCED
AS IDE" O "
SIGNATURE OF
COMMISSION NUMBER
K601A G. BACON
Ly-
1201E
(407)39"153 FloridaNm2S@rYioo.com
NOTICE TOONVNER: FAILURE TO RECORD A NOTICE OF CONINIENCEMENT MAY RESULT I\ YOUR PAYING TNVICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAM FINANCING, CONSULT -*VTTH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CONiMENCEMENT.
EXENIPT: AfC-HEAT REPLACEMENT WITH CONTRACT UNDER S7500.00
Re%lsed 03J26t2010