HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: :�il�laQao Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 467-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:�
PROPOSED IMPROVEMENT LOCATION:
Address: �Q
Legal Description: 1,J &v' fur( K IA -VL
Commercial Residential
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Property rax ID #: -o l - CO 3 - V)o , a Lot No.
Site Plan Name: Block No. �-
Project Name:
Setbacks Front Back: Right Side: _ . Left Side:
&C)z)& mFay. 36vl, 1(Q Sem L,3 dol 10 KL&) (n "CA/_
CONSTRUCTION INFORMATION:
A Ociit onawar td El
Orme un ert is perm it -'check a appy:
�HVAC — Gas Tank ❑Gas Piping _ Shutters Windows/Doors
L_J Electric ❑ Plumbing OSprinklers I Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: c,�n S�Ft.j of First Floor:
Cost of Construction: $ ! !4,� r _ Utilities: L�Sewer DSeptic Building Height:
OWN ER/LESSEE:
Name QX _,_4
Name: James Snyder
-CONTRACTOR:
Address: oft,
Company: 5nyder's Cooling and Pleating, Inc.
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City: i L (_i t — State:
Zip Code: Fax:
Phone No. Q,.3 - �J %9 - Ll
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: CACI 816579 / #26414
- __ -••...— .- ,.,•..+.._ — -W1 v, a nF%-vrcvEv NOuce OF LOMMenCeMent IS required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
of Contractor/License Holder
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_✓Not Applicable
Address
The forg ing instrument was acknowledged before me
Lday
Address:
this of M ,v-� zo.c?0by
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
(Signature of Notary Public- State ot:;Iortda) "' *
city:
x ;2 MGG 289862 •�
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Commission No. y ,S p46,dtv",{a�Q • o :j Commission No. �
Zip: Phone:
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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 Counter makes no representation that is granting a permit will authorize thepermit 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 wok or recording~ your Notice of Commencement.
of Qwner/ Le sseefContractor as Agent for Ownere
of Contractor/License Holder
STATE
COUNTYOFQRID �
STATE OF COUNTY OFORIDA / II L c�
The forg ing instru nt was acknowledged before me
The forg ing instrument was acknowledged before me
Lday
this day of 200 by
this of M ,v-� zo.c?0by
Y�
A ►rn e� C Jnj-� r �r
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known i y OR Produced Identification
Type of ddentification rv11l1N4111if1�I
Type of Identification
Traduced \��� �irtiNRL,� Producedco
t t pc��RUARY��o'• I .G��MtSSip�y C'
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(Signature of Notary Public- State ot:;Iortda) "' *
(Signature of Notary Public- State of Flor:R#) a
x ;2 MGG 289862 •�
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Commission No. y ,S p46,dtv",{a�Q • o :j Commission No. �
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SABRINA L. BLACK aFP SABRINA L. BLACDC �/AG�Undet`.���
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DATE
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DATE
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