HomeMy WebLinkAboutSUBMITTED PAPERSPlanning & Development Services
Building & Code Regulations Division �
2300 Virginia Ave. < e /�/�b
Fort Pierce, FL 34982
(772)462-1553
SPECIALTY PERMIT APPLICATION
k Electrical ❑ Plumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 foorjinstructions and additional paperwork required for specialty permits
1. Location/Site Address: ✓ '&- " /o'J U_E I
2. Parcel ID Number: SL 06 r _�o ! - ()Oq "
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3. Complete Description of Project or Work: M2 f26Q/
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Owners Information 5. Contractors Information
Name: �1Jy-
E �1<Jb� �L (LI
Address:
City: '1'V� S State: V
Zip: I `G 7 Phone:
6. Value of Construction: $ t1go'-Co
FL Reg/Cert #:
County Cert#:
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�2-7/3CT
Business Name-2Sys_
Phoffi • 73 _ 5 a :
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will
compliance with all applicable laws regulatin construction and zoning.
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PRINT OWNER OR CONTRACTOR NAME S NATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS e!'�O DAY OF `' `'�y .20 �Z .BY 6�JN
WHO IS PERSONALLY KNOWN TO M OR WHO HAS PRODUCED
be done in
AS IDED CATION.
l/ �'�'t�I I y L%� ��►liv P�•, sag
SIGN ATURE OF 0 TYPE OR PRINT NAME OF NOTARY +� 4+': B i 1- State f
1 `� r • Notary Public -State of Florida
COMMISSION NUMBER J ',,�,r �o� My Comm. Expires Dec 14. 2015
q fill%% Commission # EE 15321p
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY CE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
Property Appraiser. - St,Lucie C(\ ~ j, FL.
Frank T Tolbert 'Reoord: l of.I
Property Idontlflcatlon
Site Addresz: 3300 Avence J
Seic iamn,' snW.. 05 :3.rS AGE
h4ap 1D: 24,DSS
icning: RS 4
OVinership and Mulling
Owner. Frank T Tolbert Linda, 13Tolbe
,address: 3300 Avenue d
Fort Pierce FL'3047
Sa1031n0frnation
Date Plire. Code Dood
1t;R312009 37.500 00 WD
5;1f19e3 0 01 CV
11'ltiS9$0 350� oa GV
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PROPERTY -RECORD CARD
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TAMS IN14.611MATION I.SBrLIEV[D TO BE CORREcrAT THIS TIh1E BUT IT'IS SUBJECT TO:CHAN,0E AND [$'NOT WARPANTc,D,
Depth
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http;l.'-xvw,Ar,paslc,orQi'pre.asp?pi-clid=240570100980004 4;:27/2012
SERVICES & CONTRACTING, INC.
FL k865
DUf Number.
Phone Number.
Fax'Number:
100471526
407-422-3551
407-648.0961
Proposal No. 476998
FU 111 to]
Hoheywell,lob Name: MO Avenue J,, Ft Pierce, FL, 34947
Honeywell Project ID: Premise: 000872087
Items Descrliobn
Permit
Labors 2 Men @10 hours each
Materials
Need to, replace meter can and repair -service drop mast.
Need to re4ap feeders and install ground rod,
Amount
$
1,470.00
300.00
V')
1.wt coal
ult
Prp&ress Billing Gro.ss Amount
Note; Retention will be withheld according to the terms
and conditions of your Purchase Order
Progress Billing Amount
Shipping & Handling
Tax
Total Progess Billing Amount
$1,885.00
$1,8n,00
$0.00
$G'00
$1,889.00
I