HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Hate:,� lo�� 0�D Permit Number:
i
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: C �
PROPOSED IMPROVE ENT LOCATION:
Address Q1 i/rZ
Le a] Description: e5e.vj
Property Tax ID#: DUB - Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
�tiona work
to e e orme under this permit—c ec a apply:
�HVAC Gas Tank ❑Gas Piping —Shutters a Windows,Doors
n
I Electric r�Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ + _ Utilities: L_I Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: James Snyder
Address: Company: Snyder's Cooling and Heating, Inc.
City: , +- State: R. Address: Box20D7
Zip Code: q q Fax: City: Fort Pierce State:FL
Phone No. LPW 'l 00 Zip Code: 34954 Fax: 772-600-4811
E-Mail: phone No. 772-528-3377
Fill in fee simple Title Holder on next page(if different E-Mail: snyderscooling@aol.com
from the Owner listed above) State or County License: CAC1816579/#26414
I#value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER: V Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 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 5t.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 recordingyour Notice of Commencement.
t f Owner/Lessee/Contractor as Agent for Owner n re of Contractor/License Holder
TE OF FLO D I STATE OF FLORIDA
COUNTY OF �- lti L1 �, ' COUNTY of y� �
The forgoing instru nt was acl nowledged before me The forgoing instru ent as acknowledged before me
this day of Q21r 20 o20by this day of -ate 20 C�0 by
Ili J a 6n��I
Name of person making ftatement Name of perso making statement
Personally Known � OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
5�.�. G<a111N1i!#!!tl/i/�`/ � ��, � •,�1111iNii#!!!I Jl
(Signature of Notary Public-State of F1i�da �. 'M�l�ss1 �9 ���� (Signature of Notary Public-State of Florida)
� •: •�-1���[3ARy2Ffo��/� C p '� ' �',cBRU1s`S•• �9r1��
Commission IVaS o� �,� {5e moo ,•• Commission No_ U Z �Pa� (5e +
SABRINA L. BLACK - :x �'�
SABRINA L. BLACK = ��
Ca ° fir'289&g2 ' -.5-m
bid thl" Lgti •. y A •oh°yea h
REVIEWS FRONT ZON PLANS VEGETATION SEA TURTLE L� wtlte�y• ����
COUNTER REVIE ,IC rR� ���� REVIEW REVIEW REVIEW
DATE "fill 11111 ! ' Ji+!ll1i111
RECEIVED
DATE
COMPLETE
Rev.8/2/17