HomeMy WebLinkAboutUPSTATE-PEMRIT APPLICATIONAll APPLICABLE INFO MUST BE CQMPLETEID FOR APPLICAMON To BE ACCEPTED
Date: 1 Permit dumber:
Building Permit Application
Planning and Development Services
Building and Code -Regulation Division
2300 Igrglnla Avenue, Fort Plerce FL 34M2
Phone: (772) 462.1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
11
Address:
Property Tax ID #:
Site Flan Name:
Project Name.,
VYt>>o.wQ �Co
V'l ti
75. �� LA. ; �A4V-->
S- -bDb - D
I roe
Lot No._
Block No.
Additional work to be performZ",Ta
rider this permit— check all that aipply-
-Mechanical mnkPiping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator — Roof PItch
Total Sq. Ft of Construction:
'Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height,..,,.
L
City: Jr -C v 4AL4 5tate•1 I
Zip Code: C4 Fax.
Phone No.
E-Mail:i�
Fill In fee simple Title Holder on next page ( If different
from the Owner listed above)
Narne;Larry Licastri
Cornpany.AmedGas
Address•3301 Oleander Avenue
City, Fort Pierce - State: FL
Zip Code: 341282 Fax: 772465.8448
Phone N0772-83U740
E.MallAni6dGas-7262®amerigas.com
State or County Ucense02707128579
Ifvalue of construction Is $2500 or mare, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notiee of Commencement Is required.
DESIGNS
ENGINEER: Not Applicable
.�
MORTGAGE COMPANY: Not Applicable
Name:
Name:
..
Address:
City:
Zip:
State:
Phone
Address:
City;
ZIP:
Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:
,Not Applicable
Name:
Name,_
Address:
Address:
Cam•
Zlp: „,�.o
_„ Phone:
City:
Zip:Phone;._....
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the stork and instauation as intlscatem
i certify that no, work or lnsta0ation has commenced prior to the Issuance of a permit.
St. Lucie Coun� make; no yyrepresentation tha�Iws gran%ng agermlt will authorize the permit holderto build the subject r}E>rture
sructctcture. Pllease consultwl pyourr Home OwnersAssodation�and revlewyyour deed for atny resttrts i at Fs whiay l mayapply.
BttGi1
In consideration of the granting of this requested permit, I do hereby agree that I will, In all respects, perform the work
In accordance with the approved plans, the F16rlda Building Codes and St. Lucie County Amendments.
The following budding permit applicatlons are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residentlal use
WARNING TO. OWNER: Your failure to Record a Notice of Comm enceme result In your Pons twice for
improv .a�nts�r property. A Notice of Commence t rn a recur and posted on the jobsite
befo the 5 inspectiah. If you intend to obtain financi consu t lti, lender r an attorney before
of
STATE OF7� IDA
COUNTY OF�
as Agent for Owner
iv
Th o olne instrument w s acknowied afore me
th[day of �__ J 2iby
L GLv vL'i • 11 L t- (A
Name of peQ$a�king statement
Personally Known OR Produced Identification
Type or Identification
KRISTIE= KIRBY
;Notary Publio5tme of Flori
Commission # GG 92537
to re
STATE-QE.0
COUNTY OF
Thefnping Instru nt was acknowledged before me
this JU day of . Ii7 by
Name of perso making statement
Personally Known ✓ OR Pmduced Identification
Type of Identification
duce Yp .I KRISTIE KIRBY
= -State of Flo
t c o ary Public
Commission # GG 9253
ITA
/) ' c� My Commission Expir(
(5ignatureof Notary P i1CiJjJj of Fioridadtober 23, 2023 IlFgnature of Notary ruo+rari -
C4mmission No. (seal) Commission No. (Seal}
RI;ViE1N5 FRONT ZONING SUPERVISOR PLANS iL:RWEV
TATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW i=N1 REVIEW R
DATE
RECEIVED
DATE
COMPLEMD
Rev. 3/2/17