HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: [0119 Permit Number: 0 Vk— Cla Sq
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: (_;A S
RECEIVED
Building Permit Applica ionOEC 12 2019
ST. Lucie County, Permitting
IPROPOSED IMPROVEMENTL•OCATION: -:°
Address:
Commercial Residential 1_1�
Property Tax ID #: a� -_� L 1 l 7 1 J-1 - ��� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: „
a
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical /'�G_asTank /�GasPiping _ _Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: y
Cost of Construction: $ ` t N1 . -�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Larry Licastri
Address:.3-'�0J Ci�'aeZ hhyCr
Company:AmeriGas
City: State:
Zip Code: Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone Nc —1^1 I � 10
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Ma.. n C)(25
State or County License02707128579
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.
QN LIEN ' UV I IFQf
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SUPPI �lV1E'jVTALCrNot
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DESIGNER/ENGINEE
Name:Address:City:State:Zip:
Applicable
Ph
Zip: Phone:
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
WA TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
im rove s our property. A Notice of Commence rent A!wWith
d and posted on the jobsite
be re t e f rst insp ction. If you intend to obtain financ g, cer or an attorney before
co nc work o recording vour Notice of Commence en
Sign Lure o caner/ Lessee/Contractor as Agent for Owner
SiVnatu,.eofontractor/License Holder
STATE OF FLORIDA
SLORIDA
COUNTYOF S� ,C�
C
The forgoing instrument was acknowledged before me
. The forgoing instrument was acknowledged before me
this 11 day of T�PMV�2T . 20 icA by
this J\ day ofK�ez_� ham, 20g by
6�/l
L G '/ CI
Name of kin statement
Name of p rs n m king statement
pr'
Personally Known LTBYQ1RtI�
Personally Known OR Produced Identification
Type ofidentificatVotary Public State Of Florida
M9ela M Boore
Type of Identification
Produ
Produced v►"o Notary Public State of Florida
fission22 t90609
Or Er�ires O7J27/2p22
ng a,M Boore
:
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s
My CoWhission GG 190609
«� Expires 02]2Z/2022
(Signat otary Public -State of Florida)
(Signature o otary Public -State of Florida )
Commission No. (Seal)
Commission No.CC—> ��LOfoCA (Seal)
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Rev.8/2/17