HomeMy WebLinkAboutbuilding PermitALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: bit 1 6 c �Q Permit Number:
J
Esu>ilding Permit APplication
Planning and Development Services
Building and Code Regulation Division
2360 Virginia Avenue Fort Fierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: a [ (_ /} (;,
PROPOSED IMPROVEMENT LOCATION':
Address: — CO) Y)1ieA( e n V\ kn ,�:
Legal Description:
Property Tax ID #: r 1
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
-- F` nf
Right Side: Left Side:
M
ke
Lot No.Z±
Block No.
,L. r til Iv K(J h
CONSTRUCTION INFORMATION:
��rtiona workto jeee Dane un er t is permit— c ec a app y:
L JHVAC LJ Gas Tank ❑Gas Piping OGenerator
Shutters
11 Electric L_I Plumbing
—]Sprinklers
Total Sq. Ft of Construction: Z7o Ft. S . of First Floor:
:7,190-
-7
Cost of Construction: $-. 19 0 , -�" Utilities: _ Sewer Septic
OWNERAESSEE:
Name r
Address
City: 51�.
Zip Code:_ X34 C) W� Fax:--
Phone
ax:—Phone No. ( • 3
E -Mail: .----r—
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
DWindows/Doors
DRoof Roof pitch
Building Height:
CONTRACTOR:
Name: James Snyder
Company: Snyder's Cooling and Heating, Inc.
Address: P.O. Box 2007
City: Fort Pierce State: FL
Zip Code: 34954 Fax: 772-600-4811
Phone No. 772-528-3377
E -Mail: snyderscoolin0@aol.com
State or County License: CAC18165791 #26414
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT19N LIEN LAW INFORMATION:
was acknowledged before me
DESIGNER/ENGINEER: _ Not Applicable
Name,
MORTGAGE COMPANY:
Name:
✓ of Applicable
Address:
Address:
Personally Known i
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER. � of Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to ohtain a permit to do the work and istallation 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
comrnencin rk retarding your Notice of Commencement. s
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF
The forgoing instrut
was acknowledged before me
this dayof t
i,_ - 20,20by
Name of person,making statement
Personally Known i
OR Produced Identification
Type of Identification
Produced
(Signature of No//t'��ary Public- State of F
Commission No.u_ �
SL BLACK
'::`
REVIEWS I FRONT
I COUNTER
T46f—ature of Contractor/License Holder
STATE OF FLORIDA(?.
COUNTY OF c�
The forgoing instru as aeknowIed d be€ore me
this day of �tn� 2�by
Name of persorynaking statement
Personally Known✓` OR Produced Identification
Type of Identification
Produced
I
111111i111llfl/ll�, = �l1111NA L.
{Signature of Notary Public-
rState
�of Florida y"'
{ �� :*Commission No. -•
*. G 289 l SA B R I M LA 2' 2 #GG 289852
ifL�G 164 - /� L. r [] :Qi
`��.'a�d� and dti���x�•• �
ZDN1 .py �PLANS VEGETATION SEA TURTLE
REVI,/L; £ $1
1 REVIEW REVIEW REVIEW
+rr ar•
DATE NlIIS311i
RECEIVED
DATE
COMPLETED
Rev, 8/2/17