HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDate:
Fee Due:
# 1 1 t—!51 —
COUNTY '
FLO R I.DA-40
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 ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: ?.C16 Mc H jC-S gl V cl . )e rnsrr` eje ac �x,C 9LI'q5-1
2. Parcel ID Number: Ll 50-1- (3?�Iq U - 0Q6 "
SCANNED
BY
St. Lucie County
4. Owners Information 5. Contractors Information
Name: Ooiirnle (a E S oa'51 `hi FL Reg/Cert #: Q�5 Cl LA L 2
Address: Ci ram e (A kk Ce' County Cert#:
City: cy-d Um State: l Q y)a (`1 Cj Business Name: c or\�hj cl (n
Zip:
Phone: Phone�� �r� Fax:
6. Value of Construction:
OWNER's AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
compliance with all applicable laws regulating construction d zoning.
a�klj I9EL-A LESPOS L l 0 l
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS — DAY OF I(I20__Lj_ BY MOC VO MIN
IN
WHO IS PERSONALLY KNOWN TO MEN OR WHO HAS PRODUCED
A E ICA ON. ............ •• DAVID N. KNEPPER
�q\--A Commission #ADD 995518
a r
o= Expires Se1*hAber 25, 2014
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NO'VA&Y '••,p �;;;4e- BondedThnuTroy Fain Inwnnce800385.7019
COMMISSION NUMBER
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
Revised 04/26/2010