HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;'V D-0 Permit Number D1Q
.-.-®per
IRECEIVED
Building Permit Appli
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:
Address:
Property Tax ID #:
JAN 15 2020
Permitting Dep ment
St. Lucie Cpfinty, FL
Residential
Lot No.��
Site Plan Name: Block No.
Project Name: , \ YY\
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit — check all that apply:
_Mechanical GasTank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Constructioonn�:��� ^� Sq. Ft. of First Floor:
Cost of Construction: $ o/Jl. 3 •"I(� ? Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ^ 1FAr- I
Name: Larry Licastri
Address: M
Company:AmeriGas
City: S(Yff,TS State:
Zip Code: I 0 52Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No -TIa 4(05-388(_0
E-MailAmeriGas-7262@amerigas.com
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License 02707/28579
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.
SUPPLrItEfALfN571UCI INN LAB I�VFt7R1V1ATlOt�t
_', u
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
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 cool lict 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
WARN G TO Oay
ur failure to Record a Notice of Co en m ay It in your paying twice for
vem s tent mws a recorded nd posted on the jobsite
the first . If you intend to obtain financi ,consul h lender o an attorney before
enc' wrdine vour Notice of Commen a ent.
Sig=owner/ Lessee/Contractor as Agent for Owner
SiVatureoftractor/License Holder
DA
SRIDA
COUNTY OF SE oLt�
CF �VZ
i
The forgoing instrument was acknowledged before me
. The fnoing instrument was acknowledged before me
this lw�)) day of`SoS�o)C>3 �\\ 20Z0 by
this 1 �4 day of Sc sue_, 21[1� by
Name of lierson making statement
Name of person making statement
Personally Known _>< OR Produced Identification
Personally Known X_ OR Produced Identification
Type of Identification
Type of Identification
Produced
roduced oowR Notary Public State of Florida
or:r Notary Public State of Ficnda
+ Angela,M Boore
j r^ AngVkIM Boore
�'" �{� MY( omntlssion GG 700609
'"
My Commission GG 190606
Expires 0=712022
S µds Expires 02)E7/2022
.�.,dl
(Signs ure o o aryPubll
. Signature of Notary Public-' Stateof Florida )
Commission Nd: «Ow I (Seal)
Commission Now-C- )\CAN:Oq (Seal)
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Rev.8/2/17