HomeMy WebLinkAboutBuilding permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �] 1 b 119 Permit Number:
-,
s
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:"_ - .-- —b K-0—�
---- -
PROPOSED IMPROVEMENT LOCATION:
Address- 15b5
Legal Description:
Property Tax ID #i: 6i `TD -7 " L1 (A 1 PC04 - 000 Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I)'/C- of - Ke- u �
CONSTRUCTION INFORMATION:
Additional work to be nertormed un der this heck all [ h apply: ----- �_
®HVAC Gas Tank ❑Gas Piping L=15hutters Windows/Doors
Electric E] Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt of First Floor:
Cost of Construction: $ LJ( Utilities: � Sewer E] Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name
Name: James Snyder
Address:-6.Qn cvv CL"
Company: Snyders Goofing and Heating, Inc.
City: a - , ,P.JIt ('0' State: F -J.
2
Zip Code: Fax:
Phone No.
Address: P.O. Box 2007
City:. 'Fork Pierce State:FL
Zip Code: 34954 Fax: 772-600-4811
Phone No. 772-528-3377
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: snyderscooiing@aol.com
State or County License: CACI 8165791 #26414
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTI N LIEN LAW INFORMATION:
DESIGNERIENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY- � Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
EEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: VNot Applicable
Name:
Address:
City:
Address:
I City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 oermit 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, 1 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 toeeA'
pr erty. A Notice of Commencement must be record d and posted on the jobsite
before the first i . If you intend to obtain financing, consult with r or an attorney before
commencing orl r recording vour Notice of Commencement.
Rev, 8/2/17
n e of Contractor/License Holder
r re of owned Lessee/Contractor as Agent for owner
TATE OF FLORIDATE
OF FLORIDA j
COUNTY OF
COUNTY OF
The fQr Ding instr ent was acknowledge fore me
this ru day of 201A
The for Ding instrume w s acknowledge before me
this rb day of 20 l by
I— IT
Name of person making statement
Name of person aking stat ment
Personally Known OR Produced identification
Personally Known ✓ OR Produced identification
Type of identificationae�1ti�e01{!lIIIFFFF/�eA�
Type of Identification
Produced is°� S gRINA (, <r
Produced ,oZ44iii19lllnufli,
INA
o�tssrp,�.�9C'`R
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(Signature of Notary Public -State of Florid#FF m�
195337
' �F(nasure of Notary Public- State of Florida°] At
" a`.� n�
Y o :y
Commission No. �� �� 153 �S` A;'yp ae \ .o@
r _�r9 X337
bmmission No. 1' 1 CI 53
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLAINS
VEGETATION
I SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
I REVIEW
REVIEW
DATE
RECEIVED
LATE
COMPLETED
Rev, 8/2/17