HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATION......................
DaterN
J_Fee Due. 7 I . Permit #
St. Lucie County Building & Zoning
2300, Virginia Avenue Ft. Pierce, FL 34982-5652,
Tel..561-462-1553
SPECIALTY PERMIT APPLICATION
Electrical ❑ Plumbing El HVAC ❑ Fence
❑ Shed El Demolition rl Gas El I Ing.,
St ��° eY��l)
Seepage 2for instructions. and..ddifionatpaperworIc required for speciallypermits. , Ili/
1. Location/Site Address:
2. Parcel ID Number 17s111
Office Use
Only
Section.
Township
Range
Map Page
Zoning
Land Use
initials
3.. Description of Project or Work Activity:, _C� 4 S—C/l f e
4. Owners Information 5. Contractors Information
Name:- ZA-k-7cs &4s- S1 FL Reg/Cent Address:
rj t County Cert#. 19: 15 1�1!� LA
City:' Pc, I 1s 4, State: JiYt Business Name:
Zip: 4-( 9 "7 O� Phone: Phone b Fax TR R"a
6. 'Value of Construction-$ 1-200
OWNER'S AFFIDAVIT: I certify that all of the infbrination coritaffied in this application is correct and that all work will be done
in compliance with all applicable laws regulating construction and, zoning.
STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFOREMIETHIS;_ PAY OF
WHO . PERSONALLY KNOWN TO ME OR WHO`HAS PRODUCED
e_ AS IDENTIFICATION. KATHRYN BUMBERA
NOTARY PUBUC
STATI�bPFLORIDA
�SIG OL49 =OF WV06FARY TYPE, OR PRINT NA�Mff ORNOTARY
Cortirng D096Y559
313/20-14
COMMIS I Ev.
,TITLE: NOTARY PUBLIC COMMISSION NUMBEli—h7b, i
St. Lucie County Specialty Permit Application rev. 8125/05 drug