HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION.................................. F
-5L LUCIe t OUnty 131111CIIng OZ LUn1ng
2300 Virginia Avenue Ft: Pierce; FL 34982-5652
Tel. 561-4624.553 S
.SPECIALTY PERMIT APPLICATION
uo�A Y
, 7 Electrical ❑ Plumbing ❑ HVAC ElFence v °%61
Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork requiredfor specialty permits
1. Location/Site Address: .1 C) V
2. Parcel ID Number: U .a ` !I ? — 0 C., C
Office Use
Only
Section[Township
Range
I Map Page
Zoning]
Land Use
Initials
3. Description. of Project or Work Activity: TL l
.4. Owners Information
Name:- M;4 nq i..- G v C- c- h a 4 6- �-
e. -�e - Pe d rs k,4
5. Contractors Information
IF, Reg/Cert #: 4 o 9 9
Address:: 1.1 f d AC, I -Ile, 121v—t"... County .Cent#: �- 15 I i iA
R
City:ram, s-zs-. 1�,�'e�, State: _ Business Name: �� '
Zip; `"f `7 3` 7 Phone: Phone 3 t 0:..:415-7 Fax
410,0
6. Value of Construction: S _ �` Pd✓ cam/
OWNER'S AFFIDAVIT: I certify that'all of the information contained in this application.is correct and that all work will be done
in coinpiiance with all, applicable laws regulating construction and zoning.
�, ^Y, *,-, Lisa+
STATE OF FLORIDA, COUNTY OF jt� '� #` �r : ti� ACKNOWLEDGED BEFORE ME THIS DAY OF
20 BY "'K" V;13 1 IA.IA) WHO IS PERSONALLY KNOWN TOME OR WHO HASTRODUCE/DAs/ OWp(yA
HRYN
�' ).,•, �a . q .'� s c'_' tJ AS IDENTIFICATION. NOTARY t'lJBLIC
OF FLORIDA
_ �6115
�16TAI��Y
x •SIGN TYPE OR PRINT NAME OF NOTARY C6mM1 DD867559
7 � EXPJI€es 3/3/2014
TITLE: NOTARY PUBLIC COMMISSION NUMBER 1 t Is: �..,r ,
St. Lucie County Specialty Permit Application rev. 8/25/05 ding