HomeMy WebLinkAboutBuilding Permit Applicationt a
All APPLICABLE INF9 MUST BE COMPLETED f011 APPLICATION TO BE ACCEPTED
Date: �R to Permit Number: a00a _�j j Cj�
RECEIVED
Building Permit Application FEB 2 8 91020
Planning and Development Services
ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
h1Df1nf1CCf111fAODfOlfC0.ACAiT�1 Ar`ATIAAL• I=. . '
Address:
Property Tax ID #:
Site Plan Name: I
Project Name:
kc)\C�)—i)c)c roZ
Lot No._
Block No.
CONSTRUCTION INFORMATION:' m `
Additional work to be performed under this permit —check all that apply:
_Mechanical ;1_1Gas Tank -Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: —I G
Cost of Construction: $ L4 I O
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
''OWNER/LESSEE`.; `i ° °
'CQNT.RACTORi
Name
Name:Larry Licastri
Ad o7 .3 i f Company:AmeriGas
City: Y-F /1�/�11 I n'? State: j l-
Zip Code: �QOLJ Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone Non-Q) 44(05 49KD
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail_�IXI •�� G1110 Girl Qib
. Ccr
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.
r-
SUP[E!fENTAtaCpN51s2�lCifgNrL1ENA1(UUINF1?RMATIpN
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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
=ore�ionspec
ur failure to Record a Notice of Comme nt yIt in your paying twice for
iperty. A Notice of Commencem must b recorded d posted on the jobsite
If you intend to obtain financi , consult th lender o an attorney before
crdine vour Notice of Commence t.
Si=naturener/ Lessee/Contractor as Agent for Owner&JEOF
tractor/License Holder
RIDA
;ATRIDA
COUNTYOF Sk WyfL
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The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
thi& l day off 2t1aOby
Q`l
thisday of G S' / . 2015ZI by
cl
Name of person making statement
Name of 'per n making statement
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identificationj• ° '' ' -"
Produced 9W To,, Notary Public State of Fimr .
Produced j r;Y� °bp Notary Public State of Florida
Angela M Boore (
My Commission GG 190e09 !
Boore
�` No . Ex Tres 0 i12T02 22 190909
> No. .'E Expires 0272Z/2022
ora Expires 02127/2022
a
(Sign ary Public -State of Florida)
(Signature of Notary Public -State of Florida )
Commission NoK�Ig00069 (Seal)
Commission NcQ-C--1XR0(('(n (Seal)
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Rev.8/2/17