HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MU�ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 '1 Permit Number: I- `
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:
Address:
Property Tax ID #: Lot No. 01
Site Plan Name: /� rip Block No. _Q_
Project Name: W ikkiom
Additional work to be performed under this permit -check all that apply:
/101
_MechanicalGasTank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ to%3 .V-A
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: "''f' ' R�'
CONTRACTOR`:,
Name_wiw C" l4ene-
Name: Larry Licastri
Address:lblo C).1k1X(Iry ok)Q_
Company:AmeriGas
City?- W'k k. kIAPu State:
Zip Code: %-JQn Fax:Ll-_iU1D5-'J14
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No "In'a CIU%S- -1990
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail I�riSiAYl.pl IBr10iDaQJner14L�SCOM
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.
xSUPpLEMENTgL�GQIVSTRUCT�C?N,�L��ly�kAWf�NtFQRMAT101�'S�'z�����
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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 TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 contiict with any applicable Home Owners Association rules, bylaws or antl 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
W OWN .Your failure to Record a Notice of Com ceme suit in your paying twice for
i prov ments o your p erty. A Notice of Commence _ nt mus a recorde nd posted on the jobsite
be a th first i spection. f you interSd to obtain financi , consu ith lender an attorney before
co sencin r or rec ur Notice of Commence nt.
G 9
Sign t of ee/Contractor as Agent for Owner
se Holder
STA OF FLO DA
STA IDA
a
COUN S�— LaT_13Z
COU t 11?c
The forgoing instrument was acknowledged before me
. The forgoing instrument was acknowledged before me
this r1 day of �r?r .200 by
this k l day ofI )r.JJf 201a by
Name of pers6p making statement
Name of person inaking statement
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identificatio
Produced
Produced dr PcFt,. Notary Public State of Florida
9
mrihaw
NotaryPublic State of Florida
commMooission G
d My Commie�lon G6100009
Angela M Boorew�dr
Expires 0212712022
a(Signature
My Commission GG 190e09
" I QMZ12112
of Nota
—
(Signature of Notary blic- State of Florida )
Commission No.!-s kgO ECICI (Seal)
Commission 1\14:;G!5L5 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17