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HomeMy WebLinkAboutSUBMITTED PAPERSDate: - dt o - / f Fee Due: �� Receipt# Pi. fit # JJAJ dElectrical ❑ Shed k Planning & Development Services SCANNED i Building & Code Regulations Division BY I 2300 Virginia Ave. St. Lucie Count; i Fort Pierce, FL 34982 ' (772)462-1553 �j U SPECIALTY PERMIT APPLICATION Clzb ❑ Plumbing ❑ HVAC ❑ Fence ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 3 {� /lw�b11tt a 6Sr�s w r>ce��L399Ca 1. Location/Site Address: J r 4eviC�U`I e #'l2 q e% Kl 2. Parcel ID Number: �-�f �70/o too,5 1o®od - 3 office Use Only [!t Township Range 1 Map Page Zoning Land Use Initials 3. Complete Description of Project or Work: 1�`-n �Gl Ce ' wOv d W t CJyed CDcfe Vi U/9 r` F(7 — "D ep 4. Owners Information 5. Contractors Information Name: 9iJer5f0ne C-o*My.4rr-f-,-P Address: 9 City: r�r✓%� 1 - hgoO State: !� r Zip: ! ©d % Pho e� 6. Value of Construction: $� FL Reg/Cert #: 64Z 130/q-a_y�F County Cert#: Business Name: A m lc�l eeln Cq Phone: 6 cl `76 r &� Fax: l3 g l,') T r/ a 3 -go 3 i 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 all applicable laws regulating construction and zoning. PRINT OWNER OR CONTRACTOR NAME) A _ SIGNATURE OF OWNER ORICONTRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS QC� DAY OF 20 BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDE TIFICATION. � OF NOTARY COMMISSION NUMBER NAME OF NOTARY ' ,Jq DAWN Ni1COT�E e*; E MY COMMISSION# DD 852587 g EXPIRES: March 22, 2013 Banded Tnru i dt Publle Underwriters 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 04/26/2010 NOTICE TO OWNER: Fk -,)E TO RECORD A NOTICE OF COMMENCEMI� wIAY 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 $5,000. INSTRUCTIONS Please complete all information in the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The -information to be provided with this application includes: 1. Location/Site Address 2. Parcel ID Number 3. Description of Project or Work Activity 4. Owner Information 5. Contractor Information 6. Value of Construction Indicate.the street address or general location of property where the building activity is taking place. Indicate the tax identification number of the property where the building activity is taking place. Fully describe the activity to take place. Indicate the name and address of the owner of the property,on which activity is --taking place. Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name of the business doing the work. Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the building/construction activity. Construction value is used to determine the permit fee. St. Lucie County reserves the right to question and/or modify the indicated value, of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction. ❑ Gas Attach 2 piping schematics with tank size,location, and BTU of each appliance ❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications [II -VAC ` Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for new system or fullreplacement This application can be submitted to St.' Lucie CbimWBuilding and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications will be accepted for processing after 4':A P.M Nr assistance in completing this application, please call (772) ti 462-1553, during regular office hours (8:00 AM - 5.00 PM); Monday througfi'Friday: NOTE: Emergency electric service change out inspections will not be performed after 3: 00 PM without special arrangements and additional fee paid. Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.