HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 0/9D Permit Number:
M40-0
011111115
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 Residential
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Address:
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PropertyTax ID #: b VI )� Lot No.
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Site Plan Name: Ut Ili\ Block No.
Project Name:
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Additional work to be performed under this permit — check all that apply:
_Mechanical /--�GasTank 'IasPiping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Ft. of First Floor:
Cost of Construction: $T � . ILS Utilities: -Sewer _Septic Building Height:
ILS
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Name'OnCInCe.n
Name:Larry Licastri
Address:
Company: AmeriGas
City: State:
Address: 3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: Fax:
Phone No.
Zip Code: 34982 Fax: 772-465-8448
E-Mail:
Phone No `j-► a ' 1 lD5-I"8bU
Fill in fee simple Title Holder on next page ( if different
E-Mail Corn
State or County License 02707/28579
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
Nam
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to no are wui R a u ma a„au o
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CounnttfyyI makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which
trt ctis in ure. Please consult with your Hlome Owners AssAssociation
ciation and reviewyyour deed for any restrts ict onat s whirestrict
h rmay applyhlblt such
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 Comm ce en may result in your, paying twice for
improv r i nts o your property. A Notice of Commencem nY mus ere orded and posted on the jobsite
be re th first I spection. If you intend to obtain financirs \ nSt wtth ender or an attorney before
co a
Signature o Contractor/License Holder
Si Owner/ Lessee/Contractor as Agent for Owner
nature
STATE F FLORIDA
ST TE FLORIDA
S�-
COUNTY OF -Q
COUNTY OF �ZQ
The forgoing instrumentwas acknowledged before me
The forgoinginst[[ument was acknowledged before me
R1n\ — 20 6 by
this �-day of Q[1c-�� . 2Q0 by
this l3 day of
Vcs,��cc1��
�cfnS�C1
Name of erson making statement
Personally Known K_ OR Produced Identification
c-�y
Name f person making statement -
Personally Known X OR Produced Identification
Type of IdentificationType
of Identification
Produced lio State of Florida
$ Angela Mb Boor
Produced cState of Florida
e
tar k Angela Boore
p ?e 9
- < My commission GG t906U9
y My commission GG 190609
i
a ' ' Expires 02)9.72022
Expires 02/27/2022
a n
(Signature of Notary Ou ic- tate of lori a)
(Signature of Notary PUNIC- to e o ori a
Commission No.l�C1 (Seal)
Commission No(. C) (Seat)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17