HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONSep 04 2013 09:00 HP FaxFl Delta 86621CP-980 page 2
Date; Fee Due• Recei t# Permit # 30 00
St. Lucie County Building & Zoning Scq
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
TeL 561-462-1553 St.
SPECIALTY PERMIT APPLICATION couo
❑ Electrical Plumbing ❑ HVAC ❑ Fence
❑ Shed Demolition ❑ Gas ❑ Siding
See page 2 for instructions and alditionat paperwork re uired for specialty permits
1. Location/Site Address: ! {{�fG
2. Parcel ID Number: 0U04
[06ifilce Use
Only
Section �Tow!nssh�iRange
Ma Page Zonin
Land Use
Initials
3. Description of Project or Work Activity:
4. Owners I formation 1 5. Contractors Informtat'o
1-77 n
Name: U/ , FL Reg/Cent 4:
Address: �County Cert#:
City: ' / A111,1 State: _ Busin/ess .
Name•
Zip: <Phone � `'� Ph /e � � �' r` ✓
Fax �`✓�' c��� D
6. Value of Construction: $
OWNER'S AFFIDAvrr: I certify that all of the information contained in this applic2
compliance with all applicable Iaws regulating construction
PRINT QUALIFIERS/OWNERS NAME SIGNATL
,!T/ ATE.PF tLORIDA, COTgY OF : I ltr `i�✓�G//�I / ACKNOWL
// 20 :_) BY 0
TITLE: NOTARY PUBLIC
St Lucie County Specialty Pennit Application rev. 8/25/05 dmg
WHO IS
AS IDEN
is correct MiRW al I work will be done
-7
OF QUAL[FMYVOWNER
:D BEFORE ME THIS DAY OF
KOWN TO ME WHO HAS PRODUCED
TYPE OR PRINT NAME OF
COMMISSION NUMBER
DECENtBI&MLL
Notuy P000 • 816tt of Fla "
My Comm. Expire® Jul 81, 2017
Commission # FF 006220