HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:, ee Due: Receipt# r' Permit #
Planning & Development Services SCB�NED
Building & Code Regulations Division
2300 Virginia Ave. �S(: I_uc.
Fort Pierce, FL 34982 COUnfy
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical lumbing ❑ RvAC ❑ Fence
❑ Shed Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty perndts
1. Location/Site Address: s
2. Parcel ID Number: �53 Z— F d 00 j — 000 -A
Township Range Map Page Zoning d Use Ini ' Is
Office Use Section
Only
3.
4. Owners Information
6. Value of Construction: $ A5D, OD
5. Contractors Information
FL Reg/Cert #: [ �F 1,'. 1-{' z, 14q 2-
County Cert#:
IBa§i Name:
d2 one: 2 -3— Fax•
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is c ect and thatall work will be done in
com with all applicable' laws regulatin struction and zon' g. s`
Cy
OWNER OR CO CTOR NAb
ME I SIGNAT V OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF C51 • ) Cal `C1
ACKNOWLEDGED BEFORE ME THIS DAY OF Q 20� BY
WHO IS PERSONALLY KNOWN TO ME -"'OR WHO HAS PRODUCED
IDENTIFICATION.
IVIy QOMMOMM10:
SI AR ATURE OF NOTWV"'
T E OR PRINT NAME OF NOTARY
C MMISSION NUMBER[. EW 4�
1 0
.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
vF;
Revised 04/26/2010