HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDue: L9 Receipt# Ll L N
St. Lucie. County Building & Zoning
s { 2300 Virginia Avenue Ft. Pierce, FL 34082-5652
Tel. 561-462-1553
SPECIALTY PERMIT APPLICATION SCANN
By Et)
Electrical ElPlumbing. ❑ HVAC ElFence fit' Lucie County
Shed ❑ Demolition ❑ Gas ❑ Siding
Q$
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address:
2. Parcel ID Number:" —
Office Use
Only
Section.
Townshi .
Range
I Map Page
Zoning
Land Use
Initials
3. Description of Project or Work Activity:�'r1
4. Owners Information 5. Contractors Information.
Names Tpiryt d w4,,,, e, L b o14 S FL Reg/Cert#: 1'
Address:
�� l� till Li 14 'u _ i2 d County Cert#:
City:
ems• Wit,►-� State: //t4
Business Name:
Zip:
hone:
Phone 3'7 b -°' 'M). Fax
'-3 3`R --4>` ?? L
6. Value of Construction: $ , 7 A 5
OWNER'S AFFMAVIT- I certify that all of the information contained in this'applicatibn is correct andthit all work will be done
in compliance with all applicable laws: regulating : construction.and.zoning.
STATE OF FLORIDA, COUNTYOFY Yam.; z` t -; tit ACKNOWLEDGED BEFORE ME THIS vZ.% DAY OF
20 BY. 6 1, {A_t� + WHO IS PERSONALLY KNOWN TO ME,OR WHO HAS PROpUCED
1cA'rhlRYN 13UMI§ERA
k I~ s E a AS IDENTIFICATION. NOTARY PUBLIC
j ESTATE OF FLORIDA
cnrnn*@� W7 559
s1GNAT RE OF NOTARY TYPE OR PRINT NAME OF NOTARY 18� t ttR IMS 3/312614
TITLE: NOTARY: PUBLIC COMMISSIONNUMBER'9 1 d °^+r
St. Lucie County•Specialty Permit Application rev. 8/25.105 ding