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Building Permit Application
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Cd Date: /1-7 Permit dumber: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Residential Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERMIT APPLICATION FOR: % KU PROPOSED IMPROVEMENT LOCATION: Address: 5V Legal Description: r r](Do I — �� ` 7 Lot No. Property Tax I D #: `� _. Block No. Site Plan Name: Project Name: I Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: ot." l,r Kc, tri e� r ! D Gal `a � L I D14i 41,J CONSTRUCTION INFORMATION: 4tjona wor to e e orme un er t is permit— c ec a app Y' A H!!AC � Gas Tank ❑Gas Piping _ Shutters Q Windows/Doers Q Electric Plumbing Sprinklers 01GeneratorQ Roof Roof Pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cyst �f Construction: $ '9 Cost 0-0—utilities Sewer Q Septic Building Height: —. ___� OWNERAESSEE: Name Address: 2� 4 �P �-1 ✓1 �2JL4— City: + State: Zip Code: _;�L4!1 j Fax: Phone N.� S $ E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed alcove) CONTRACTOR: Name: James Snyder Company: Snyder's Goofing and Heating, lne. Address: P-0. Sox 2007 City: Port Pierce State: FL Zip Code: 34954 Fax:772-600-4811 Phone No. 772-528-3377 E -Mail: snyderscoolingt�7a aol.com State or County License: GAC 1816579/ #26414 If value of consiructian is $Z50Q or more, a RECORi3ED Notice cif C®mmencement is required. SUPPLEMEN IAL CONSTRUCTI DESIGNER/ENGINEER: Name: Address: City: Zip; Phone ON LIEN LAIN INFORMATION: Not Applicable MORTGAGE ColMl PANY: Name:. Address: State: City: Zip: Phone: FEE SIMPLE TITLE HOLDER: � Nat Applicable 'BONDING COMPANY: Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: ,-'Not Applicable State: ✓Not Applicable 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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure structure.which is com let with with pyplica Home e Ow Association �ssociatsandcin rreviewbylaws your deed for covenants r any restrictions which may aprohibit such In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments_ The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory 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 yo r property. A Notice of Commencement must be recorded and pasted on the }obsite before the first in tion. If you intend to obtain financing, consult w' lender or an attorney before — - commencing tar recordin your Notice of Commencement, 5i of Owner/ Lessee/Contractor as Agent for Owner ture of Contractor/License Holder TE OF FLORID _ STATE OF FLOR Ll� OUNTY OF . LL-'- L--4 C' COUNTY OF_ The for ing instru nt was cknowledge� efore me The for oing instru ent was acknowledged before me this goday of �h this day of Cd+r 20 �7by O� Name of person king statement Name of person aking statement Personally Known OR Produced Ide tific� Personally Known OR Produced Id b o�`°jNA.L�Bf�i�i Type of Identification o 1tR l . to Type of identification YP '`� •"'••��'���i �N 5�'••�5$fQ `.;�' t�p� i Produced ,��' ": •"gn1a"�IC111t• Produced e r•O�a9V2,�FrAj•.• % 4pnTV2'�Jo�0•• CJS + �* •* ,� a-� Q ` #FF 1953'x7 q .. sgnature of Notary Public - state of Flci� g ; oma; Si nat (SR1 f� Ru.bE+ LMft)f Ff'j }y a .`��: - %Q�°•? 44dedw.,4�: ". g �/� �� °F' /;Q� Commission bio. �r 05 t pl 11i111t101e�a� co w �iti li 4i1 ANGRO REVIEWS FR ©NT ZONING SUPERVISOR PLANS VEGETA�ON � S � TURTV EWES MR VIE COUNTER REVIEW REVIEW REVIEW REVIE i GATE RECEIVED DATE CPLETED Rev. 8/2/17