HomeMy WebLinkAboutJohns - 133 Camino Del Rio SLCALL APPLI E }NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:l o�D ��}( 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: D r — 'U Y -,Le— K ►
PROPOSED IMPROVEMENT LOCATION:
Address: !(. 35 OClf1` -i00 d i i (D Ce iC�q�7
Legal Description:
Property Tax ID ##:
Site Plan Name:
Project Name:
Setbacks Front
t✓17 Jl A l-- -
41a-7 - I I I. 0 a as - OD a, S
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�C C)h -, U �'e- U k,
J
Lot No.
Block No.
CONSTRUCTION INFORMATION;
Additional war to e e orme un er t rs permrt — check a apply:
HVAC 0 Gas Tank E]Gas Piping _ Shutters Windows/Doors
E] Electric El Plumbing Sprinklers Il Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:_
Utilities: 0 Sewer Septic
Building Height:
OWNE ESSEE:
CO TRACTOR:
Name 4 lkv)C' I
-WafaV. James Snyder
Addre I n �
Company: Snyder`s Cooling and Heating, Inc.
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City: �f` T l�--t State: ��.
Zip Code: oZ. Fax: a
Phone No. —7-7c2 - 23L4 q
Address: P -C. Box 2007
City: Fart Pierce State: FL
Zip Code: 34,954 Fax: 772-600-4811
Phone No. 772-528-3377
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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: CAC1$165791 #26414
-a• �. •+..�, �,.�,.,,, ,.� ,�s.aai� ul IIluiv, d nrl—umuLU IMOUCe Oi commencement Is required.
SUPPLEMENTAL CONSTRUCTLIEN LAVH INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: � Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: jZNot Applicable
Name:
BLINDING COMPANY: Not 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 County 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,,4ork or recording your Notice of Commencement-
01ature of =0wnrJLe,,eJCor tractoas Agent for Owner,,o047aTture
of Contractor/License Halder
STATE OF FL,O 1
NATE OF FLORI A
COUNTY OF c + e�
COUNTY OF _J, L uc,+
The for Ding instrumet was acknawledg before me
this day of G 20a0by
The far Ding instrum was acknowledged before me
this day of .20 by
JOr
Name of persa making atement
Name of person making statement
Personally Known OR Produced Identification
Personally Known .✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
t
NALIfq����
�?k'NA
' • �'
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(Signature of Notary Public- State of Fi�'3ida) ®�y2Lp �
{Signature of (Votary Public - State of Flori��,i�UARk2
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Commission No.G 92&J- = (Seal}
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Zommission No. G I ,_. Seal �.
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SABRINA, L. BLACK �o .o Gza9a82
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REVIEWS
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
CCeMPLETE0
mev. 6/7-/1-7
110