HomeMy WebLinkAboutWALLABYS PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date. _ _ Wa! ] (f/Aff Permit NllfrlbeC.
Building Permit Application-
Planning and DevelopmentServfces
Building and Code-Regulation Division
2300 Virginia Avenue,Fort Pleme FL 34982
Phone:(772)462-1553 Fax:(77z)462-1578 Commercial ' Residential
PERMITTYPE: k .� tAI\ �04 614t S
P1,10 NOW�5 .
Address:._r �1 A ky%(A"+'iy_il& 1 � � . �1'►��—[� �-� (�ticJVt.� � � 1 L4_
Property Tax'ID#: 1 LA?A - S ' b NA - D''1 Lot No. S
Site Plan Name:
Project Name.
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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 Pftch
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction:$ L. C1 IWT Utilities: —Sewer —Septic Building Height:
,�.__ .-t; ,1=• ;�;�.a.re.,a Qom; ' '- L"
La Licasid
Name Name' �Y 1
Address: IL- IU k �3r COmpany:AmeriGas
city; state: 1 Address•3301 Oleander Avenue
Zip Code: �P Fax' City: for#f'le:rc® State:FL
Phone No. b 1 Zip Code: 34982 Fax: 772-465-8448
E=Mali: a ` k 140. Phone N0772-633-0740
Fill in fee simple Title holder on next page (if different ?.'AailAmer!Gas-'1262@amerigas.com
'E-MailAmeriGas-7262@amerigas.corr4
from the Owner listed above) State or County Llcenseo=7128579
ilvalue of construction is t25170 or move,a RECORDED Notice of Commencement is required.
If value of HVAC Is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY, ,,,,,,,_Not Applicable
Nefne: Name:
Address: Address:
Cltyc State: City: state;
l
Zip: Phone Zip: Phone: -
FEE SIMPLE TITLE HOLDER: „_,,,,,Not Applicable BONDING COMPANY: _,,,,blot Applicable
Name: Name:
Address. Address,
City: City: -
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as Indicate&
I certify that nor work or Installation has commenced prior to the Issuance of a permit.
St.Lucie Count�yy makes no representation that lg granting a�armlt will authorlie the permitholder to build the subject ure
which Is In coMict with anyY�ppllcable Home nggrs Assodatlon rules,bylaws$r an covenants that may morict or prod it such
srructure.Phase consult w>;ti your Home Owners^mdadon and review your eed for any restrictlons which may apply.
In tonsideration 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 Floilda Building Codes and St.Lucie County Amendments.
The following bullding permit applications are exempt from undergoing a fall 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 fallure to Record a Notice of Cammenceme result In your paying twice for
Improv nts roperty.A Notice of Commence"tco;m�su
e reco and posted on thejobsite
beta the s inspe o ifyou Intend to ob�taln#inanc Ith lender r an attorney before
tn
Slgnatu a of O ntractor as Agent for Owner 5 nature of Co trkctor/LICense Fielder
SPATE Q RIDS►, STA IPA ff
COt1NTY OF_ _r . "l��1/ COUNTY OF T V M I uAn M V�t
thisgoing Instru e t acknowie before me The rf�o�Sing instrum n�tw�s acknowied efare me
day of 2 by this io-s-�,day of. eV 21 by
L "^� —Ilk,r I~ 6 L-A- v v� l.i t t4
Name of p son king statement Name of persooaking statement
Personally Known AR Produced Identification Personally Known OR Produced tdentlflcaton
ype of Identification a of Identification
KRISTIE KIRBY
ra uce � .�
ra„ duced.
Public-State of Flori + �e°;,`s
KRISTIE KIRK
�= Commission # GG 92537 -_ _Notary Public-State of ida
%��.. My Commission Expir Commission # GG 92 3 0
October 23, 20234L
foF,�P,. My Commission Exp r
tslgnature of Noiary Pul bl c-
Commission No. (Seal) Commission No. (Seal)
i REVIEWS I FRONT O�NT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REV EWI REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
i
RECEIVED
DATE
COMPLETES?
Rev.8/2/17