HomeMy WebLinkAboutPolonsky - 6506 Woodsmere Way SLCALL APPLICABLE INFO MUST BE COMPLETES? FOR APPLICATION TO BE ACCEPTED
Date: �4J �1 0_ _ Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2309 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: .411, jkJ— ,, Ke—, E
PROPOSED IMPROVEMENT LOCATION:
Address:�Q s oty Lub c)66R WC. w O -LA _ �_+ • f r "Ce- �Licf5l
Legal Description:a� i -�- bj, 733 La
Property Tax I D #: !I� f D7 ` 00 O 000 - _ Lot No.
Site Plan Name: Block No. 73
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
��itio ial work to be performed un er t is permit — check all appy.
LJ HVAC LJ Gas Tank ❑Gas Piping _ Shutters Windows/Doors
LI Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �a % � Q ✓
S Ft. of First
j Floor: _
Utilities: E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Q i�n,-5
Name: James Snyder
Address: LP5'D5rY)ei(z
Company: Snyder's Caoling and Heating, Inc.
City: F1 . Pr " Statei—V
Zip Code: Fax:
Phone No. �� LO '_�
Address: P.O. Box 2007
City: Fort 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.com
State or County License: CAC1816579 I #26414
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR.UCTI LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: E-'Not—Appli:cable 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:
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 theermit 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 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 property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing; vu-dfk o?tecording your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLQRLQ4-
COUNTY OF . �_L'k- U
The forgoing instr gent wa acknowledged before me
this day of r i Z 0by
Name of person making statement
Personally Known of OR Produced identification
Type of identification
Produced
'PO
ontractor/License Holder
iTF FLOI ,,,, j
COUNTY OFy"tt-- f Ltd
The for Ding instru nt was cknowledged before me
thisdayof L4r i O :20 by
es C-51�'qdew-
Name of person aking statement
Personally Known Og Produced Identification
Type of identification
Produced
;1!4144,1{1#111
A
f ! I C �I�/V//
of Nota Public -State of rich' o��aissrDw'•, C` ��i
(Signature N
��pt]AhY?Efoi
(Signature of Notary Public- State of Florid` ��gRINA(.e �/ii,,f
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No. f�CB * Seal) ��n�=
.•Q',Missloy.;�90
Commission No
Commission
SABRINA L. BLACK o :o �^,yes sz -*"
SABI, ,tA' L. BLACK
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Rev. 8/2/17