BUILDING & ZONING DEPARTMENTS
2841 Old Dixie Highway ● Fort Pierce, Florida 34946
SPECIALTY PERMIT CONTRACTOR AGREEMENT
Shed
Demolition
Gas
Siding
Driveway
Deck
Other___________________________________________
Contractor Certification Number:______________________________________________________
Trade or Type:_____________________________________________________________________
Project Located At: _________________________________________________________________
Describe Contract Work/Remarks:_____________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
It is understood, that, if there is any change of status regarding our participation with the above mentioned
project, I will immediately advise the Building & Zoning Departments
Owner:___________________________________________________________________________
Address:__________________________________________________________________________
Phone Number:____________________________________________________________________
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor’s License)
ORIGINAL SIGNATURES ARE REQUIRED
Business Name:____________________________________________________________________
Address:__________________________________________________________________________
City/State/Zip:_____________________________________________________________________
Phone:___________________________________ EMail:_________________________________
OFFICE USE ONLY
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