HomeMy WebLinkAboutBuilding permti appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q q 1,=�t a-P Permit Number:
J
•
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 v"� Residential
PERMIT APPLICATION FOR: A-1 C ChoiYa_Yr d�,Ke_ �_ay Lik
PROPOSED IMPROVEMENT LOCATION: i
Address:�p
Legal Description: �e.... ('�iti.y►�vu 1 ✓aJ- "A I b }-1/; if �GVf 0
�P_. Lb -�
Property Tax ID #: �3 3A" TD - nc)D3 - bc)o -9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
A l C, al O_AA� 0->i .- L"� Kp- U
CONSTRUCTION INFORMATION:
Additional work to be erformed under t is permit _.. c e[ a apply:
0 HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
In
Electric 0 Plumbing 05prinklers Li Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
o
Cost of Construction: $ 717 4 q 6�O _ Utilities 0� Sewer 0Septic Building Height:
OWNERILESSEE;
CONTRACTOR:
Name
` ,v-�
Name: James Snyder
Address: 6-2 3PLk (5�,
Company: Snyder`s Cooling and Heating, Inc.
City: av+- State: e
Zip Code: � 41 'l Ll Fax: �"
Phone No. —71 a — qU 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@aoi.com
State or County License: CAC1816579 1 #26414
voruc ur Luirzv ur uuer a -t3uu or mare, a KtLUKUtU 1votice Ot LOrnmencernent is required.
I SUPPLEMENTAL CONSTRUCTi N LIEN LAW INFORMATION:
DESIGN ERjENGtNEFR; Not Applicable
Name:
MORTGAGE COMPANY. Not Applicable
Name: —
Address:
Address;
City: S te:
Zip: Phone _
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name;
BONDING 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 the permit holder to build the subject structure
which is in conflict with any applicable dome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit, 1 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 roperty. A Notice of Commencement must be recorded and posted on the jobsite
before the first ins ion. ou intend to obtain financing, consult with lender or an attorney before
commencing w or r rdinp, your Notice of Commencement.
i
S" t of Owner/ Lessee/Contractor as Agent for Owner
ature of Contra ctorAicense Holder
.00
ATE OF FLORIDA
COUNTY OF_
STATE OF FLO I j
COUNTY OF_.
The forgoing instrument was ac awledged before me
this �200b
The forgoing instru ent as acknowledged before me
clay of by
i this o%.Liday of C�,�'�4---Ue , 20 p2O by
Name of persaking statLkment
Personally
Name of person aking statement
Known 1 OR Produced Identification
Personally Known L- OR Produced Identification
Type of Identification
Type of Identification
Produced
r�luul�r�+r��
Produced
"11111v
B
'/�rN0iA L+ a
C15510/yo
(Signature of Nott�aryy Public -State of Florida : ���`� °
` �Aiure of Notta�_ryy Public- State of Floridan
Commission No.G, �`9-q gio a (SCE)*
C�nrr ision 6 of b ! bd � '� ' •.a
�Gzs ?sz
SABRINA L. BLACK ��T ��� e°RaedYn�°
`rj��y b�biic
No. (seal tcc289M2
I
��.y � i SABRINA L. SLACK as d B
1Da�fi.
tSnde�'F'
p0°nded
nc' blic Uod
REVIEWS
FRONT
ZONING
L!C sTAqIN���`
Su� lRi�ii R
PLANS
VEGETATION
SEA TURTLE
��Llr_ ...77•O
MANGi�Ui�,ll0
COUNTER
REVIEW
REVIEW I
REVIEW
REVIEW
REVIEW
REVIEWN
DATE
j
RECEIVED
DATE
COMPLETED
Rev. 8/2/1