HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/1 1 /� Permit Number:
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
PERMITTYPE: il LOQ
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Address:
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Property Tax ID #:D 04 Lot No.
Site Plan Name: Block No.
Project Name: 1
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Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
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Total Sq. Ft of Construction: \C)\,5 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
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Name P nnQ.1
Name: Larry Licastri
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Address: —
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Company:AmeriGas
City: State:_�FL.
Address: 3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: Fax:
Phone Noll - a31
Zip Code: 34882 Fax: 772-465-8448
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E -Mail:
Phone N�
Fill in fee simple Title Holder on next page ( if different
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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.
Name
City: State: _
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _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
WAR O Your failure to Record a Notice of
im ovemen ,o your p perty. A Notice of Commenct
be re the firs nspectio If you intend to obtain finan
It in your paying twice for
and posted on the jobsite
or an attorney before
Rev. 8/2/17
ure of 0 er/ Lessee/Contractor as Agentfor Owner
Si nature of Cc tractor/License Holder
STA OF ORIDA
STA RZ�
COUNTY OF SV L•Y ��2
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
2Qa"P by
this tS day of 20�by
this day ofMCU`G_
Name bf person making statement
Name of person making statement
Personally Known X_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification Py, No�ry Public State of Florida
Produced r tagc Puhlir. State of Florida
n M Boore
Angela M Boore
My Commission GG 190009'
a' my Commission GG 190009
R' Expires 02127/2022
7 Expires 0=712022
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No..(= GoVcMC" (Seal)
Commission No.%moo "c_'45Zq (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17