Loading...
HomeMy WebLinkAboutBuilding Permit Application Date: ee Due: Recei t# Permit# Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. • Fort Pierce,FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION Electrical 13 Plumbing 13 HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 fore instructions and additional paperwork required for specialty permits 1. Location/Site Address: ) "l T�Jb 1 AI) V f:9.- -D (� 2. ParcelIDNumber: 5©�{ ' ��0"®�� ® " 000— Township Range Map Page Zoning Land Use Initials Office Use Section Only 3. Complete Description of Project r Wk: em'ALA- t',4) 0 i 1N L 4 1- d 'Q "fee J CA ° i TS i ly Id1�.T�f�� fA E�i.a-J � L Ib IJ�/T Pii� �D?.XJU t ld�I�-2 ���lJ '�i*�'��� „al tY' 4. Owners Information o 5. Contractors Information Name: 1 6yi„ FL Reg/Cert#: �C��6 cn, ��33 Address: 1 �,N�j �� R, -Q County Cert#: City: �S State: fG Business Name: I°r �, i C Zip: 349 S Phone: Phone• 12- _ .�� . -)Fax: 77 1 3 i o 6. Value of Construction: $ 2, O OWNER'S 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 constructio z-o 'ng. .5; 'er PRINT OW OR CONTRACTOR NAME SIGN OF O ER OR CONTRACTOR--___ ' ARSTATE OF FLORIDA,COUNTY OF .)IJ ACKNOWLEDGED BEFORE ME THIS DAY OF o7� ,20—L—ev_BY JP�/�Mh( q& flfl(fer WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED A IFIL apt;•':�B CHRISTINA R.ZELENKE # * MY COMMISSION I EE 827899 Anim-66 9016 (seal) SIGNATURE OF NOTARY �l''FoFFlo�°'t YEPoNOTARY. COMMISSION NUMBER 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