HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABV /4INFO PNUC1ST BE COMPLEreu FOR APPLICATION TO BE ACCEPTED
Date: c/� 7 /W Permit Number:
6% •61r0
Building Permit AppliC tion•
Planning and Development Services F" 2 9 ?020
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Per ing
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: �O e
I=PROPOSEOIMPROVEMENT�LOCATION
Address:
Property Tax ID t#:
Site Plan Name: .�
Project Name: _
i 01,� � Block No.
CONSTRUCTION INFORMATION:"' ' ,
Additional work to be performed under this permit —check all that apply:
_Mechanical -'�GasTank Piping _ Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / 1) 1 r �U�. ��/ Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
"'OWNER%LESSEE: '' ''' `
CONTRACTOR: 4
Name c5
Name: Larry Licastri
Address: 11fi9
Company:AmeriGas ,
City: "4 1 n— 1SWD1 State: jL9L
Zip Code: c3uC-1 CJ `y Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 `` Fax: 772-465-8448
Phone N% Jo (0
E-Mail_.Ot5W?- Fb) I oncc) Qme/ j Cd
State or County License02707/28579
E-Mail:
Fill in fee simple Title Holder on next page ( if different
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.
� 4+. p�SAuC'r�, ^Tzw tYe#A` _;, a+'i' y}� M�pj � R�
SU(tV(Glr�"iJxIVi
cY'?.'rs�'=n%�d."2{ i 5
Y •g,,' s...
'i'Y ,. '.
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 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 contlict 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
/NE Your failure to Record a Notice of
your plipperty. A Notice of Commence
spectio . If you intend to obtain fill
It in your paying twice for
and posted on the jobsite
or an attorney before
!Lessee/Contractor asAgent for Ownerntractor/License
tSTAOF
Holder
aCO
L
ORIDA
+-�t�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
2i by
thisi day of 20.0 by
this= day of Q�
Liz, -c--,/ L..x
—
Name of person making statement
Name of person making statement
Personally Known? Produced Identification
Personally Known trees
—OR
Type of Identification
Type ofldentificati jo'M"O'trF Notary Public state of Florida
Angela MBoone
Produced ,.V Notary Public State of Florida
M Boofe
Produced isalon GG ieoi
ge a
ray Commission GG 19090e
wa Expires 02M7/20T2
Pa r� Expires 0212712022
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida )
Commission NoqC- <L\ C!R (Seal)
Commission Ni (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17