HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due: �teceipt# Permit #
Planning & Development Services
Building & Code Regulations Division 'S
2300 Virginia Ave. �'q/I/�
Fort Pierce, FI. 34982 �t e y �®
(772)462-1553 410/e COO,
SPECIALTY PERMIT APPLICATION
"Electrical
❑ Plumbing
❑ HVAC
❑ Fence
❑ Shed
❑ Demolition
❑ Gas
❑ Siding
Seepage 2 for instructions and additional paperwork required for specially permits
1. Location/Site Address:
2. Parcel ID Number: cQ 196 0 00
Office Use
Only
Section
Township
-Range
Map Page,
zoning
Land Use
Initials
3. Complete Description of Project or Work:
/� I /Q Or r�— )c�:f_ �
r- b Q S -C. t" 1�9 0 4 I r
4. Owners Information 5. Contractors Information
Name: Jen n 16 za I c Z FL Reg/Cert #: �� �,�� a 5(a �rI'%�
Address: 1 %� 1 o a K / IV Y County Cert#: c/ 3q
City: F:ar'�" r'G-e, State: r4-- Business Name: 600f(X�J A,
r � 4
Zip: L l ClcM Phone: Aar— ) YPhone: M- qZZ- 3551 Fax: - W 3 Orti(O 1
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
Sco pliance all applicable laws regulating construction and zoning.
h4Wn e
PRINT OWNER OR CONTRACTOR NA�p
/ SIGNATURE OF OWNER OR CONTRACTOR
,,.
STATE OF FLORIDA, COUNTY OF vV 4 r/
ACKNOWLEDGED BEFORE ME THIS Z DAY OF i n 20. BY
WHO IS PERSONALLY KNOWN TO ME O OR WHO HAS PRODUCED
AS Ti �Aup.
/ Z -.5 v�dP �.�o4,pr peaky BETTY LATSONAS
TYPE OR PRINT NAME OF NOTARY R N Public - State of Florida
GNATUREO N T Y ,�f c�c� W Comm. Expires Dec 14. 2015
S3 2, ���i/�OGFts, Commission # EE 153212
COMMISSIONNUMBER -J �����"�
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 0412W2010
ProP.-M Appraisq:- SMU01(1 FL
Jobn1d donwbi f,58-0 Rscordz I of I
Prope'r4t Idantification,
SIWAM� lees: Zflning
Givneiship and M6i6(ng.
1204'OAK AV-
R S
jenole Gwwlez �gsrjl
1201 OnkMo
Fart F15W,�,L 34982-60,06
DI(a Privo 'code
i thil -- 7 G, 75000 00'
5JJII1,9'74 11500 01
Dead
ov
CY
p4ge 1 0t 1
PROPERTY RFC jRD CARD
-PTQv No:kt >> Sodc,Aitsuvt)t Taxhs Exemilifloni; Poronft Homii Print
M�,
,Ac -qwrt 33124.
'Si Lude. C wifity
Legall Das&lptlon
LOT I DALAL LOTS 19 k,IdR 20r,(G,Plz A
More—
Msoomerit 9611 Final Toiall Land aria suiii!16,8
'Bcok-Poge ;zo f 1 rinat 1,00 700 Lam Val,Aix 25200 Awes: 0,'62'
0319;20W Amessejd! 100700 a wilding lapse;" 755()&
bVS ' 13050 A'a"cre"Alt 0 1 Fir*41o'dAmM 261195qFf
25200
BUILDING INFORMATION
RncoG1qN.,Pc
SA, - AE-011 Shingle
'RojpjSirmct:
HP -Flip
HG7HC
Yearil'T
1970
F,,ame-
1076
ftgnev..Iall:
BS - ce Stu=
0610- 1 Story
No.Unlw
I
Inthrldr Ft3aturas
IX m MAXIM)JI4
PImirtWell"
bliq - broiall
Full Biih: 2
FHA - FrcclHoWr
MaOFI;
STO,
Hoa!F60:
TLfC - Woonk,
Prrfj.Plorq,,
carpet
I %l4eatod.
1w
Special Features and Yard Itenis
Land Infotm4Uon
s.,Y�a; �iS LBW:
IJnitr� dual, Bcnd. '?rBlt.
:'Vc�. Laid tits`
typa
•'Ada"s:ife
3001'- 30GT 8 1 0000000001 AV AV 1970
1 0 log.8F Rd
N-Front!71
1$4
PIPSF - SITE:DEV $-F Y, 1
1 AV A.1V 2001
THIS.-MI'09MATION IS O;r-LIEVED TO. BE CORREQTf,T THISTIME
11ANbl N
BUT IT ISSUBJEqTTor6jIANG 8
o T� xtF a
W RM4TE
Depth
140
N SE RACTING, INC. RVIC81 & C034T
red Stre 6t:
DUNS NutAber:
ANJ1526
Phone Number,
407'422-,3,551
Fax.Nurnbet
407-648-01961
Proposal No.. 474757
O.IdneVw,ell Job Name; IZOI, Oak Avenu.e, Ft Pfej ce, FL 349,8�
Honeywell Pro; ed 111); Premise: 000849927
items
I Permit
Labor; 2 Men Hqurs each
Broke-116e'side jaw% meter •tan d I arnaged.
2" ICE C. pipe encase In con:qrete. Pipe Is outside of meter
base and line side -wire needs to, be extende&
Need to replace ffiet6 can-andneed to repair 2" 1MC
pipe.
vQ
Amount,
119.00
$
Viogyess, 131111i"s-, Gr9a Artipufit I r UZ-2214.0
Note: Retention. Will be withheld'according to the terms
and conditibris of your Purchase Order
PrqFnes.Billlng Amount 1,72116.0
$hipping& Handling
Tax
Total