ST LUCIE VILLAGE
BUILDING & ZONING DEPARTMENTS
2841 Old Dixie Highway Fort Pierce, Florida 34946
SPECIALTY PERMIT CONTRACTOR AGREEMENT
Electrical
Shed
Door
Plumbing
Demolition
Window
HVAC
Gas
Shutters
Fence
Siding
Dock
Roof
Driveway
Garage Door
Sign
Deck
Encl.
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
(PRINT NAME)
(DATE)
Business Name:____________________________________________________________________
Address:__________________________________________________________________________
City/State/Zip:_____________________________________________________________________
Phone:___________________________________ EMail:_________________________________
OFFICE USE ONLY
PERMIT #
FEE
ISSUE DATE
RECEIPT
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