HomeMy WebLinkAboutBuilding Permit Application Date- Fee Due: Receint# Permit H
Planning& Developnient Se ices
Building&Code Regulations D Dision
2300 Virginia Ave.
Fort pierce,FL 34982
(772)462-1553 Fax 462-157:8
SPECIALTY PERMIT PLICATION
0 Electrical Plumbing ❑ HVAC 13 Fe ce
ID Shed' [I Demolition 0 Gas 0 Siding
Seepage 2for insImcdonsand addWonalpaperwork required' edaEw permift L4
1, Locatiou/Site Address: R1 MIDX-f iohw -F+ �In �1-
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2. Parcel ID Number- 2YO'
V-"Coc'
3. Complete Description of Project or Work 11 .. mk
4. Owners Information S. Contractors Inform tion
Name: FL Reg/Cert
Address:
County Cert#:
City: .1 a 41 Nu �t C
�h ;State.. fl Business N
Zip. Phone: gr,03 72- L4
phone:-T,
6. Value of Construction:S to
OWNER-SAFFWAVIT.- I certify that all of information contained in this applicati is correct and that all work will be do-ne m
compliance with all applicable laws regulating construction d zoning.
PR RTr OWNER OR CONTRACTOR N 09ATM*(?F,�E (3YCbNM&CTOR
STATE OF FLOPJDA,COUNTY OFIa
AC ,TOWNO
LEDGED BEFORE THISDAY Giz 120_L'�
BY
IATHO ISPER�ONAI.LYKKOV�NTO ME—ORWHOEAS PRODUCED
1E 13YU
AS EN I TION
........... WALTER AMOLD
aq pubiic
Slate of Florida
cu.Expires A-19 16,2015
MNATURE 01"NOTA RY TYPE OR?RrNTNANffi'OFN
lary Assn.
CO" MMISSION NMARER
*ALL RESIDEN-i[AL AND NONRESIDENTIAL STRUCTURES ARE RFQURW,-D MEET THE FLOOD ZONE
ELEVATION OR IS]NICHES ABOVE THE CROWN OF THE ROAD,WHICMV:ETS APPLICABLE. EE 9461
(see instructions on
reverse side of this sheet)
Revised 03f1812OM
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