HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONDur,:
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
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SPECIALTY PERMIT APPLICATION
IM Electrical ❑ Plumbing ❑'HvAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty
1. Location/Site Address:
331S
)�_ AUK
2. Parcel ID Number: I`J� � � coo/p _
Office Use
Only
Section
Township
Range
Map Page
zoning
Land Use
Initials
,I1
3. Complete Description of
6')C,/8
4. Owners Inffoormation ) 5. C ractors Information
Name: �J ��i /� O CJ`L J�% ! �� e I KrFL Reg/Cert #: L f 3o a i 666
Address: 33 l C69v9Qc 40 z--'.County Cert#: 2% 7V
City: — � �� Mate: /"f, Business Name: ZX ez ",
Zip: Phone: Phone: 305233 �'_VZax: 3oS --Z 3 3
6. Value of Construction: $ ` v o '
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 regulZ2���
n
f Wr�f�_AC
PRINT ER R CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 3 a DAY OF 204,�_ BY ap6o;z7 >
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION. /��
k" //Y ?a '_j 5 (seal)
SIGNATURE OF NOT Y TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER Z6 A
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 WITII YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 � Pus, DIANA L. MATTHEtNS'
(0, `�01% Notary Public -State of Florida
Revised 04/26/2010 • E My Comm. Expires Sep 19, 2014.
%ham •��� Commission #r EE M24
\ •����� Bonded Through National Notary Assn.
. T
NOTICE TO'OV*MR: FAILUR , _, J RECORD A NOTICE OF COMMENCEMENT AL-161' 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 $5,000-
INSTRUCTIONS
Please complete all information in the space provided. All information must be printed (use black or blue ink
only) or;#typed: This'' permit application is to be used only for those activities that are not otherwise included
under a,prnnary building permit. This application may not be used for any activity that includes structural
alteration. The information to be provided with this application includes:
1. Location/Site Address
2. Parcel IID Number
3. Description of Project or Work Activity
4. Owner Information
5. Contractor Information
6. Value of Construction��
Indicate the street address or general location of
property where the building activity is taking place.
Indicate the tax identification number ofthe
property where the building activity is taking place.
Fully describe the activity to take place.
Indicate the name and address of the owner of the
property'on which activity is taking place.
Indicate the State of Florida registration number (if
applicable), St. Lucie County contractor license
number and the name of the business doing the
work.
Indicate the total value of the work to`take place.
Total cost of construction includes' all current retail
material and labor costs associated. with the
building/construction activity. Construction value is
;used to determine'the permit fee. St =Lucie County
reserves the right to question and/or modify the
indicated value of tonstruction if ,it�-is demonstrated
that the submitted figures -are notycon, sistent with
similar types of construction.
® Gas Attach 2 piping schematics with •tank size,location, and BTU of each appliance
® Shed: Attach 2 plot plans, 2 copies of IDCA letter and plans, 2 anchor specifications
® Fence Attach 2 plot plans showing location of fence height of fence and type of fence
® Siding Attach 2 copies of manufactures specifications
® HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for
new system or full replacement
This application can be submitted to St. Lucie County Building and Zoning, •2300 Virginia Avenue, Fort Pierce,
FL 34982. All permit applications must be filled out completely before submission. No applications will be
accepted for processingafter 4 30'P.M. For assistance in completing this application,aplease call (772)
w;
462-1553, during regular office hours (8:00 AM - 5;00 PM), Monday through Friday.
NOTE. Emergency electric service change out inspections will not be performed after,3: 00 PM without
special arrangements and additional fee paid.
�5 p
00 issuance ofthis,perm required inspections can be scheduled by calling (772) 462-1261.
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