HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1-2- x[I do a(D Permit Number:
LLLIlC
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L; L `' ti Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: A/C Change out - Like for Like
PROPOSED IMPROVEMENT LOCATION:
Address: � 7b5 N . 41 UJ A-
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
1/Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 00 o , Utilities: —Sewer _Septic Building Height:
OWNER LESSEE: CONTRACTOR:
Name Name:James Snyder
Address:r9-05 NUJJ Mk Company:Snyder's Cooling and Heating, Inc.
City: State: . Address:P.O. Box 2007
Zip Code: 3 �Jq LlcJ Fax: City: Fort Pierce State:FL
Phone Nojl(7 - q W6 • 3101 Zip Code: 34954 Fax: 772-600-4811
E-Mail: Phone N0772-528-3377
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 CAC1816579126414
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION;
DESIGNER/ENGINEER: +Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zi p: 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 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County a osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lende an attorney before commencing work or recording o tice of Commencement.
ignature of owner/Lessee/Contractor as Agent for Owner nature of Contractor/License Holder
STATE OF FLOR _ STATE OF FLORIDA
COUNTY OF C .0--- COUNTY OF C.t
Sword to(or affirmed)and subscribed before me of Swo�rPto(or affirmed)and subscribed before me of
Physical Pre nce or Online Notarization '� Pqhysical Presence or Online Notarization
this day of __ 2020 by this oL day of J)ec_ .� 2020 by
e / ev—
Name of person making staternerit. Name of person making statement.
Personally Known OR Produced Identification Personally Known '`,_', OR Produced Identification
Type of Identification Type of Identification
P duced Produced
?ANA L.B ���os �� }NA L.g Xrii��
(Signature of Notary Public-Sta e of Rj$rida �M� N e M�s"ON •,
9 ^�R .•Sea� Ry2����• (Signature of Notary Public-State of Fl��da����MY?�fN• ,,
(Y N 9 0 Loc_ �, off•.
Commission No. - ( ) Commission No. ;(Seal
SABRINA L. BLACK r: �•�' '*G 289862 SABRiNA L. BLACK 862
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COUNTER REVIEV�/i��'gzkC S REVIEW REVIEW REVIEUV'�4j�a<c
DATE t Ofllllill
RECEIVED
DATE
COMPLETED
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