HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1S53 Fax:(772)462-1578 Commerdai Residerltia4 V
PERMIT APPLICATION FOR_ To aHek-BFF914a${hfe pnrt of ling
PROPOSED IMPROVEMENT LOCATION: ` j �Le ' � L
Address: 'i l
Legal Description:
Property Tax 1D#l: 0A 00Q A Lot No. ` q
Site Plan Name: Block No.
Project Name:
Setbacks Front Bach. Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I& ne
Ulop.a
STRUCTION INFORMATION: I
wor to [e�e� orme un er t is permit—c ec a a app y:
1?0H00,VAC L_[Gas Tank FIGas Piping _Shutters L1 Windows/Doors
1-1 Electric 11 Plumbing 11 Sprinklers E]Generator Roof Root pitch
Total Sq. Ft of Construction: Sq. Ft. of First Fioor:
Cast of Construction: $ � • Utilities:[]Sewer Septic Building Height:
OWNER/LESSE,E: CONTRACTOR:
Name Q Name: James Snyder
Address. p4)i c ��`'1 llrr 't- Company_ BnYder's Cooling and Heating, Inc.
City: Y : State:,a Address: F'.O. Box 2007
Zip Code: 3q s Le 1 ax: City: Fart Pierce State-FL
Phone No. "`] f I Zip Code: 34a�4 Fax: 772 600-4811
Phone No. 772-528-3377
Pill in fee simple Title bolder on next page(if different E-Mail: snyderscoo)ing@aol.com
from the Owner listed abarre) State or County License: CAC1816579/#26414
i
If vatue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIPN LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: _ _ Name:
Address: Address:
City: State: City: State:
Zip: Phone ' Zip: Phone:
FEE SIMPLE TITLE HOLDER: �Not Applicable BONDING COMPANY: ____Not Applicable
Name: Name:
Address: Address:
City: city:
Zip: Phone: Zip: Phone.
�I
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, 'bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your'Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, i do hereby agree that I will,in al3 respects, perform the work
in accordance with the approved plans,the Florida Building Cedes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a Mi concurrency review: room additions,
acce5sory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your pro .A Notice of Commencement must be recorded and posted on the jobsite
before the first inspect- . f intend to obtain financing, consult with !en r an attorney before
camrner�cin work co our Notice of Commencement.
Sia r caner/Lessee/Contractor as Agent for Owner n O;c2
ator/License Holder
E OF FLORNr 5 ,ATE OF FLORIDA f
COUNTY OF ` COUNTY OF
The forgoing instr_ument was acknowledged efore me The forgoing instrument was acknowledged before me
thisdayof �a(ri.�ca.�/ 2(] by this 1 G` r 20ff by
Qairk-S r j�ej"'
Name of person aking s�nt Name of person aking statement
Personally Known OR Produced [dentification Personally Known OR Produced Identification
Type of identification Type of identification
Produced Produced
%A o'$"'t INgtlft���jl�l _ YtRi+Vf�'/ill
(Si ature of Notary Public-State of FIO da• Doti' i'GSI 4,,• `�1 (Signature of Notary Public-State of i
i I q` 1 . •' uary � i
SABR1 L• BLACK
Commission No_ �= !Seal) ��m: Commission No. 33�/
Q'v 'fhru
�// �f•L_.'�o7'fififf2''p�.�..+�Q.��1 /l�r./ � +a•.•+• ()�•1\.�\
REVIEWS FRONT ZONI 81' rS R PLANS VEGETATION SEATURTL E 1 �f�/ r E
COUNTER REVIEW rt�#��W REVIEW REVIEW REVIEW IL y
E
DATE
RECEIVED I
DATE
COMPLETED
lieu.8/2/17
I
BUILDING &CODE REGULATION DIVISION
23M VIRGINIA AVENUE
FORT PIERCE, FL 34982
r- L ia L 1 b Lt 772-462-1353
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
Permit #
Credit Card Users: 1.501b Surcharge added per transaction
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
',-'VISA -- MASTERCARD
Credit Card Number 63 003
Expiration Date Zip code _ ..
3 digit security code
Amount . _ + 1.5% surcharge
Dusiz ess hdaii� : ' `�'
Qc r _Ln
Authorized Signature:
Print Name:
Phone: t
Fax: '.1U) &[
Comments:
SLCPDSD Pevised 4/01/2010 EN