HomeMy WebLinkAboutBuilding Permit AffidavitA\
All APPLICABLE INFO MUST BE COMPC �'ED FOR APPLICATION TO BE ACCEPTED M� /2 n
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Date: Permit Number:
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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
PERMITTYPE: �=� F�S
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
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Q.l-P f-E i
'WORK��'^ ,
CONSTRUCTIONINFORMATION:
Residential /
Lot No.
Block No.
Additional work to be performed under this permit — check all that apply:
_Mechanical 'Gas Tank "'Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: / /
Cost of Construction: $ QQ � `4 • �J'
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE-: `'
�CONTR4CTOR
Name-rf
Name:Larry Licastri
Addre s: I Lc�.S t.Q
Company:AmeriGas
City: State:fL
Zip Code: Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No -DL4 �D
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailAmeriGas-7262@amerigas.com
State or County License02707/28579
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.
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DESIGNER/ENGINEER. _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
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 priorto the issuance of a permit.
St. Lucie Court 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 R: Your failure to Record a Notice of
impr e s to yoLlkproperty. A Notice of Commence
bef re the i t inspect n. If you intend to obtain finan,
It in your paying twice for
and posted on the jobsite
or an attorney before
curtimenu
Si=ture wner/ Lessee/Contractor as Agent for Owner
Sign ture of C ntractor/License Holder
LORIDA
STAT OFF ORIDA
5V l
COUNTY OF S� L-Ii, ." Q
COON F u4Z
The forgoing instrument wks acknowledged before me
The forgoing instrument was acknowledged before me
this �day ofMSClC�� �
this a, day ofmS&s •2dWbY
.20aQby
Name of pers n making statement
Personally Known_ OR Produced Identification
Name of persbn making statement
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Produced u lic State of Florida
Produ A°r Note Publk Slate of Florida
Angela M Boore
Angela M Boore
My Commission GG 190609
' 0218'(n022
1� My Camr�1'lsslan OG 180808
S ?or Expires 02 12022
a Expires
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission NoCG lc{��OFI (Seal)
Commission NoG(:C� 1 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17