HomeMy WebLinkAboutSPECIALTY PERMTI APPLICATIONwizoal')Jv-�'
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1555 S1r �C'9
SPECIALTY PERMIT APPLICATION
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Electrical ❑ Plumbing ❑ HVA:C ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty per►nits
2. Location/Site Address: OC-r-4 tlJfttt -7 Z9-
2. Parcel ID -Number: C,>O % "? - C' G G - `f
Office Use
Only
on
Township,Ran
a
Ma Page.
Zoning.
Land.Use
Initials
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3. Description of Project: or Work Activity: T14-3Me j
4. Owners Information 5. Contractors Information
Name: it1i>(4,4a-_: _d-aa,-A 4 C, fqG A FL Reg/Cert #:
Address: ea 8",' t
City: f2r �'w.,' ► f State: l ,
13
County Cert##:
Business Name: A_...0:a.3;'s, .P_C.
Zips f & 3 i Phone:.2.29 A 99—& Phone 3_:l0-4Y-- Fax
6. Value of Construction.�
OWNERS AFFIDAVIT: I certify that all of the information, contained in this application is correct and that all work will be done
in compliance with C applicable laws reguladng,construction and zoning:
STATE OF FLORIDA,, COUNTY OF �r t a ACKNOWLEDGED BEFORE ME THIS DAY OF
20, BY 0�, 1,3 �__ (-Qi a,) WHO IS PERSONALLY KNOWN TO ME OR WHO HAs:PRODUCED
KATHRYN ts.UMEeRA
AS IDENTIFICATION. NOTARY PQBUC
_ 1 'Cl
STATE OF FLORIDA
<-� - ,i- tom, �.b`t t rn O s is �. Comrnftb9S7559
SI�AURE�kOTARY_�_ TYPE OR PRINT NAME OF NOTARY i8
_ � �1reS:313/2014
TITLE: NOTARYPUB! IC COMMISSION NUMBER _I 3s has ;
St. Lucie County Specialty Permit Application rev. 8125105 ding