HomeMy WebLinkAboutSUBMITTED PAPERSDate: JQ Fee Duo. _,,j L f . DD Receipt# Permit #`15
Planning & Development Services
Building &Code Regulations Division
2300 Virginia Ave.
r Fort Pierce, FL 34952 11-pw
(772)462-1553
SPECIALTY PERMIT APPLICATION
Sc
❑ Electrical ❑ Plumbing ❑ HVAC 210'Fence St gy�F�
❑ Shed ❑ Demolition ❑ Gas ❑ Siding Uc/e C�
See page 2 for/instructions and additional paperwork requiredfor specialty permits
1. Location/Site Address: � 6 0 3 ,7ttRA' 14 AVro/ ► • _/ r+ c° r-c
2. Parcel EDNumber: /Yf3A ` t0 ( — 005 1 — 000 — I
Offica Use
Only
Section
Township
Range
IMap Page
Zoning
Land Use
Initials
G •-'S'
S'
3. Complete Description of Project or Work:-nf7V 150l Lf o7C 6' Aogh uA46 PVC
aCr-OSS &e 6ac% Lol Aa ow. A; ZiS?a// /40' L a><' �4' hi4`i OV41,,
-fence d �yi'c,�t'n d o�aaey eCqua& k4-Ween e nighiors
4. Owners Information 5. Contractors Information
Name: Hovs4
A44iof'l'11/
L1;&
6i rorT A'ewce FL Reg/Cert#:
Address: JC
Or0kag e,
V
County Cert#:
4-1
City: f� r� P i e- rG e, State:
efSC/255V-78'
C255a1
PvG
F'L• Business Name: t!anmcrcrA/ FenCt Con+raC7 !rS,ZnC.,
Zip: Phone: ?7)-216-1?6SPhone:L560;58q-177q Fax:(q'o7)`33(`7q$q
6. Value of Construction: S 16 goo • °o
OWNER'S AFFIDAVIT:
contained in
compliance with all applicable laws regulate
MINT OWNER OR CONTRA TOR NAME SIGN
STATE OF FLORIDA, COUNTY OF a
ion is correct and that all work will be done in
and zoning.
OR
ACKNOWLEDGED BEFORE ME THIS DAY OF QC- , 2
�iHIlllll0i/p0�
BY "��
OR WHO HAS PRODUCED
WHO IS PERSONALLY KNOWN TO ME/
ATION.
_ t r
*S:SION
ONOFN40TAKY TYP OR -PRINT NAME
OFNOTARY !�/d •.��SSIWWO?��'•
/-� 2 �I
NUMBER �C� 7'/ 1/
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
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