HomeMy WebLinkAboutBuilding permit app r -
All APPLICABLE INFO MUST BE COMP D FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
Building Permit Application o
Planning and Development Services u �u
O
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 W. L.; S N
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 8
PERMIT TYPE:
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Address:
Property Tax ID#: 7��" JrC� d-// '- j Lot No.
Site Plan Name: / "fir, Block No.
Project Name
Se ��U �'�l�r�.n ��P�X✓�-7e, /ate/� Lan AL
Additional
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Additional work to be performed under this permit-check all that apply:
_Mechanical XGas Tank , Gas Piping _Shutters _Windows/Doors
Electric _Plumbing —Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ �' 312 Utilities: —Sewer _Septic Building Height:
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Name h r / G,y[� jj Name:Larry Licastri
Address: 73 o_ Data lJG P>l,- Company:AmeriGas
City:PW sc,;-14 c e. State: 0'5e- Address:3301 Oleander Avenue j
Zip Coders V5,r2' Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34982 Fax: 772-465-8448
E-Mail: Phone No772-633-0740
Fill in fee simple Title Holder on next page(if different E-MailAmeriGas-7262@amerigas.com
from the Owner listed above) 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. /
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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: _Not Applicable
Name: 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 conflict with any applicable,Home Owners Associationrules,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[,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 exemptfrom 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 OWNER:Your failure.to Record a Notice of Com cement may result in your paying twice for
im eVsur property.A Notice of Commenc ent mu `re ed and posted on the jobsite
b. ore thspe ion. If you intend to obtain finan ing,consu with len r or an attorney before
co n ' ---
Signs ure of O essee/Contractor as Agent for Owner Sig ature of ontractor/License Holder
STATE LORIDA STA E OF LORIQt1k_
-COUNTY OF S� k, s. .0U OF
The forgoing instrument was pcknowledged before me The forgoing instrume t was acknowledged before me
this3o day of 7�c 2 � by this day of 2(�O by
L
� ���� csxS n
Name of person making statement Name of pe son making statement
Personally Known _OR'Produced Identification Personally Known _OR Produced Identification
Type of Identificatio Type of Identificati
Produced 4 �<4� N�NPubiicStateofFiorida Produced Yat.
�c State of Florida
Angela M Boore Angela M Boore
My Commission GG 130609 a My Cartmission GG 190609
orw Expires 02l27/2022 or Expires 02127/2022
�'`�`Y` (Signature of Notar Public-State o i a ,
(Signature-of ry Public-State of Florida) ( g y
Commission No(:�U1g0roZ1 (Seal) Commission NQA�=>kq(Z)w 1 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev:8/2/17 -