HomeMy WebLinkAboutbuilding permit (2)All APPLICABLF INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: az) 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
PERMIT TYPE:
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Address:
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Property Tax ID #:
Site Plan Name: Block No.
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Project Name: e
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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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
11(� Height:
Cost of Construction: $ Utilities: —Sewer Septic
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Name
Name: Larry Licastri
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Add s:nCn�CVn_(d�—
Company:AmeriGas
CityO1�l 1A� 0 State:FL
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code:3yG3412 Fax:
Phone No.
Zip Code: 34982 Fax: 772-465-8448
E-Mail:
Phone No __VtQlAU5
Fill in fee simple Title Holder on next page ( if different
E-MailAmeriGas-7262@amerigas.com
State or County License02707/28579
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.
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
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 msLadeddu
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CountyY makes no representation that is granting a permit will authorize the permit holder to build the subject structure
strucis in ture. Please consult with applicable
Hlome Owners Association and review your daws eed for any restrictions tlons which maor
applyhlbit such
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
rethe
R Your failure to Record a Notice of Co ence m esult in your paying twice for
iemen to your pl' perty. A Notice of Commencem t must e ecore and posted on the jobsite
fir ection. If you intend to obtain finand g, nsult lende or an attorney before
-_n .�__._._...�.�.. - '1
co en rrc Al
I
Si ature of Cc t tarl4i ense Holder
Sig ature of Ow er/ Lessee/Contractor as Agent for Owner
STA F F RIDA
COUIN \
E OF F RIDA
SOU
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
2d;Qby
this\ day of Jv`. 2Qg by
thisoit day o l\,
s
L c-c�-y �s gL-
Name of er n making statement
Name of pel on making statement
Personally Known �><_ OR Produced Identification
Personally Known
Type of Identification
ype of Identification Ott NotaryPublic State of Florida
Produc o"'•� Notary Public of Florida
M sioore
r'My
a° n M Boore
r0 uced a My Commission GG 160600
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My Commission GG 1fi0809
Expires 02/27/2022
EKPires 02127/2022
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(Signature of Notary Public -State of Florida)
(Signature of Notary Public- State of Florida)
Commission No.q;liCo �9�� (Seal) -
Commission No.q-- Z) (Seal)
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ZONING
SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17