HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Elate: � D d 1� � j Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-155.3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED
IMPROVEMENT LOCATION:
Address: � GzI�ne O �S � i- 4:7+ tW C'e_'
..ryryt��195%
Lega I D esc ri pti a n: Id �n S1� i'r1C c5� j �A J�O
Property Tax II? Lot No. �SO
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I C' C"hc� O-LJ , LJ Kc A>e- U e,
CONSTRUCTION INFORMATION:
Adclitional work to jene orme € n ert €s perm€t —checka t apply:
RIHVAC L_I Gas Tank Gas Piping Shutters a Windows/Boors
DElectric 0 Plumbing O Sprinklers 01 Generator Roof Roof pitch
Total Sq. Ft of Construction: St
of First Floor:
Cost of Construction: $ ��� UtilitiesSewer Septic Building Height:
OWN.ER/LESSEE:
CONTRACTOR:
Name
e1
Name: James Snyder
Address:I I oi15 (2- V
ft�R�'P_o
Company: Snyder's Cooling and Heating, Inc.
City: i L-eState:',
Zip Code: 3� -i6 j Fax;
Phone No. '7 7 — - C) a
Address: P-O. Sox 2007
City: Fart 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: snyderscooling@aol.corn
State or County License: CAC1816579 I #26414
.. vt 4VIEZU Vl.1tVil tz� 4m-auv or more, a Kt[.uKLJtU Notice or commencement is required.
SUPPLEMENTAL CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER]ENGINEER: V Not Applicable
Narne-
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER- � Not Applicable
Name:
BONDING COMPANY: at Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 w€ll 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, 1 do hereby agree that i will, in aii 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 your 9,roperty. A Notice of Commencement must be recorded and pasted on the jobsite
before the first ' sp Ion. If you intend to obtain financing, consult with le�ide� are attorney before
camrnencir or r recording your Notice of Commencement.
ure of Owner/ Lessee/Contractor as Agent for Owner
a` o Contractor/License Molder
T ATE OF FLORID]
C®i I NTY oF�
i ATE OF FLORID, 1 j u�
COUNTY OFy i�
�-r
,
The forgoing instr en w acknowledged before me
The forgoing insuumen was acknowledged before me
this day of �f , 21)� by
this j O day of �fl_L by
eAl
Name of person aking statement
Name of person y aking state ent
✓
Personally Known 1OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
i Produced
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{Signature of Notary Public- State of Flori�� :: �E. • C'�_
ignature of Notary Public -State of Florida
Commission No.C-5c:5- 3g9wPZ _i5ea1) pew ;
rnission No. �� I��DdZ ea
ry •�„><—
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SABRINL_ BLACK ' Ina
SABRINA L. BLACK
_
REVIEWS
FRONT
ZON€13L�//�r� SUPE�9iSC ���PLANS
VEGETATION
SEATURTL''
COUNTER
REVIEW li REVIEW
REVIEW
REVIEWDATE rr
$• 1� •'��a
NA..•..c��Aj*
RECEIVED
,,"\:Sl�0
DATE
COMPLETED
� �� ARr� off,•. G
:,� a tirion
Rev. 812/17
IGc 289862
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