HomeMy WebLinkAboutHawkins - 4665 S 25th Street SLCALL APPLIIFA LE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �`h02.�9i b-J,U Permit Number:
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milli 11-11MENOMMkv
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenge, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: A k, -(?-/ha�
PROPOSED IMPROVEMENT LOCATION:
Address: Cp ' v�tL CS Jim
Legal Description: 5,e, Lo ✓ a Le" ol
Property Tax ID Q M 5 - 00D -49 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C_ moj 0"j K C t) J< U_) hIan &Y-
J
CONSTRUCTION INFORMATION:
Ad d it! ona I wo rk to e e f Orme un ert is permit — c e a app y:
HVAC 11 Gas Tank Gas Piping Shutters Windows/Doors
Fl
�l p !? � / rs
FlElectric 7 Plumbing Sprinklers M Generator Roof Roof pitch
Total Sq. Ft of Construction: S�Ftj of First Floor:.
Cost of Construction: $ �g®�� Utilities: L_I Sewer ElSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Df "_M
UIKI 1
Name, James Snyder
A
Address: MPJr 5 • d5 &
Company: Snyder`s Cooling and Pleating, Inc.
City:State:
Zip Code:, 3149 Fax;
Phone No. - • qLP11 • 419'9
Address: P.O_ Box 2007
City: Fort Pierce State: FL
Zip Code: 34954 Fax: 772-690-4811
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
a. — — L L ull,Li LIL.LPG!! i> A;3giu or more, a KLLtJKL)tU NQZICe of (AMMencement i5 required.
SUPPLEMENTAL CONSTRUCTI N LIEN LAW 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: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Blame:
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 will authorize thepermit holder to build the subject structure
which is in can llict 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 spection. If you intend to obtain financing, consult with lender or an attorney before
commencinu6c, or recording our Notice of Commencement.
re of Owner/ Lessee/Contractor as Agent for Ownerure
of Contractor/License Holder
STATE OF FLORI -
I STATE OF FLORItA
LI
COUNTY OF_-( -.1/� _4C'
5[
COUNTY OF i - %
The fo oin instrum
I3 g as acknowledged before me
The far oin instrumn was acknowledged before me
g g
this day of 20,Wby
this ay of fnwt� 20 d-0by
n lelv
Name of person mg staten4ent
dame of perso aking statem nt
Personally Known V, OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
�11hI�IIRIIf/l/� IAtA(
u /vw Civ
`��y ', •o RIyA
(CtR1�lY'•
(Signature of Notary Public -State of Florida��
.�,phhhllgs�� ;
of Notary Public -State of Florid} .'
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Cammission No.�St� 9�0(_a1),�'
ynature
orn�riission flio.��`
L. BLACK
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SABRINA L. BLACK�� ,n,U �
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Rev. 81211.7