HomeMy WebLinkAboutSUBMITTED PAPERSy-r
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
❑ Electrical
❑ Plumbing
❑ HVAC
❑ Fence
❑ Shed
❑ Demolition
)KGas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 5100 �rF' �-rD�c► l irY t
2. Parcel ID Number: Iq If) " 211 - o03 O p 000 — 3
3.
S
S ceNNFO
t, Y
UCie Coon
ty
Office Use
Only
Section
Township
Range
Map Page
Zoning
Land Use
Initials
Description of Project or Rork:
4. Owners Information 5. Contractors Information
Name: Flo I le vl Pi ® n er, Je-m es FL Reg/Cert #:
Address: 5-I 00 T e"to l Y-cu
City: SAC- State: FL_
2'16_Z5 i 15�
County Cert#: 2_%'3®C)
Business Name: I`110Y1 LiGti ETC+ S ELXOrez
Zip: Phone: Phone: Phone: _701-i I al Fag:
6. Value of Construction: $ 1�92 0 '
OWNER'S AFFIDAVTT: I certify that all of the information contained in Ns application ' correct and that all work will be done i
compliance with all applicable laws regulatingz45z'oer4d,19
uction ang.
"AmG� C .-C��
PRINT OWNER OR CONTRACTOR NAME SIGNATM OF O O ONTRACTOR
STATE OF FLORIDA, COUNTY OF S-� . L V C, 2
ACKNOWLEDGED BEFORE ME THIS 'J DAY OF
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED Cr 'a
AS IDENTIFICATION.
f6kahr0.
SIGNATURE OF N ARY TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER
13 BY a1 Vh S t 61 r
y ro - y (-.I 1 1 d;�:NA GIVENS
Notary Public - State of Florida
My Comm. Expires Dec 16, 2016
Commiog9 # EE 858761
Bonded Through National Notary Assn.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
l IMPROVEMENTS TO YOUR PROPERTY, IF YQU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORD&&T YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
FILE COPY
' .
i;301 L 0 0
ST. LUCrE COUNTY BUTLI)rgG DIVISION
REVIEWED FOR OMP
REVIEWED BY
DATE_ -f
PLANS AND PERMIT MUST BE KEPT ON JOB
OR NO INSPECTION WILL BE I%I"E-
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