HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIIC4 BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D�� t ) I q Permit Number:
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: Al U ol-� L1
PROPOSED IMPROVEMENT LOCATION:
Address: / C fI �"• i Q�t�i? ��- ��qJ�D
Legal Description: �_.. ; Q Farm,-5 Q 5 Jam` 4/0 Jam. d�.L �� �!}p �C�✓ f p-f"
�,ro�p
k' 1��1)4
rty Tax
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: night Side: Left Side:
CONSTRUCTION INFORMATION:
Additional work to MasTank
orme under this permit- c ec a n apply:
ZHVAC Gas Piping _ Shutters Q Windows/Doors
Electric Q Plumbing 05prinklers 11 Generator E]Roof Roof pitch
i—
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � bD , V0 Utilities:nSewer ESeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name � 0 12.P
Name: Jarnes Snyder
Address: U149
Company: Snyder's Cooling and Heating, Inc.
City }� _ State: Gt,
Zip Code: �� 7 Fax:'
Phone No. -7
Address: P C Box 2007
City: Fort Pierce State: FL
Zip Code: 34954 Fax: 772-600-4811
Phone No. 772-528-3377
E-Mail:
Fill in flee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: snyderscooling@aol.com
State or County License: CAC18165791 #26414
IvaIuc vi wMuuLnUn ES:?zatiu or more, a KtLUKUtL) i1louce of LorY mencernent is required.
SUPPLEMENTAL CCNSTRUCT N LIED LAW INFORMATION:
ION:
DESIGNER/ENGINEER: --_ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
' City:
Zip: Phone:
Zip: phone:
OWNER/ CONTRACTOR AFrFIDVIT: 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 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 concur.rency 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 your property. A Notice of Commencement must be recorded and posted on the jobsite
before the firs sp tion. If you intend to obtain financing, consult with lender or an attorney before
cominencin fo or recording our Notice of Commencement.
i lure of Owner/ Lessee/Contractor as Agent for Owner
ure of Contractor/License Holder
STATE OF FI.ORI _ -
COUNTY OF j �uc-� �—
STATE OF FLORIDA
GOEiIUTY ®F LUk
The forgoing instrument was acknowledged before me
l this & day of 20 by
The for Ding instru nt was acknowledged before me
this day 2-01 by
of
ev-
Name of perso making statement
Name of persa} making statem t
Personally Known t� OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type cf Identification
Produced
Produced
P C.�
"•1
ire . s .
(Signature of Notary Public -State of Florida " �,�$ARY�
' .•(Si ature of Notary Public -State of Florida
Commission No.GG- 9,996Oi ( a4'j;
emission € OUIo� e.•�
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REVIEWS
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VEGETATION
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COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
R
BATE
RECEIVED
DATE
COMPLETED
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Rev. 8/2/17