HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLEINFOMUST BE COIL':..«TED FOR APPLICATION TO BE ACCEPTED
Date: I - - l - I r Permit Mum
Building Permit Applicatim
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
PERMIT APPLICATION FOR: Fuel
-9.
DEC - 9 2019
Permitting Dv artment
Fie C-6unty, FL
Address: IU L)U17(Y It-" \ Y(
Legal Description:
Property Tax ID #: !4 - �� - Lot No.
Site Plan Name: Block No.
Proiect Name:
Setbacks Front_ Back: `C] Right Side: LeftSide:1C-)
G-1Qllan janK Pvu� l C7 �� oC= eXk ^L�rie yr Too t.
Ve, -�o �cako�rl ��\ Ye� I -I I ord
cat. C�noj W aA-eir
HVAC D
Electric 0
Gas Tank
Plumbing
EfGas
Piping
Sprinklers
❑_ Shutters
Generator
❑
Windows/Doors
Roof
FI
Total Sq. Ft of Construction: 1 Cyr
Cost of Construction: $ `�'1 ` C7-�
S Ft. of First Floor: _
Utilities:]Sewer USeptic
Building Height:
;OWNER%LESSEE';
CONTRACTOR:
Name 'c^Uung
Name: Larry Licastd
Address: rJ� S7f l C Y \ _ L�
Company: Amen gas
City: I t?. oe Stater.
Zip Code: �21 Fax:
Phone No.-:I-n - goo ^
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No. y kzi�----4��(_p
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
r lY1SEFl\•�o� \(7Y 7 Wfr1CQS - C� r1
State or County License: 02707/28579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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`��`�N��` �j�'''��`�'�'� �c�'� ''�'��� s '�`'
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 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
WARNING TO :Your failure to Record a Notice of C;et
encef esult in your paying twice for
im vem is to your operly A Notice of Commence must a recor and posted on the jobsite
be re the fi inspectio If you intend to obtain financi nsult h lende or an attorney before
corn encin w or g vour Notice of Commen ent.
Sig ture of Ow ee/Contractor as Agent for Owner
tractor/L ense Holder
STATE O ORIDA
LORIIjCOUNTY
UTE
OF �!— cI� 1S2
\y-jz�
The forgoing instrument was acknowledged before me
. The forgoing instrument was acknowledged before me
this —day offSgg--&? S�1—\\, 20 1t by
this i-i day of Qp`M T' . 20 t� by
Q rr v 1 cACc t�
t
Name of pe)rs(on making statement
Name of pets n making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentificationR
Type of Identification
Produced Notary Public State of FloriEa
Produced Notary Public State of Florlds
M Boore
M Boom
�i MY Commission GG 190609
9p Expires 02/27/2022
My Commission GG 190809
�5.wr Expires 02127.12022
(Signature of Notary Public -State of Florida )
(Signature of Notary Public -State of Florida )
Commission No. (Seal)
Commission NoG9a\- A-k99 (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