HomeMy WebLinkAboutBuilding Permit Application i
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
ALL APPLICABLE INFO
Date: 2(.1 Permit Number: 'f .+
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APR 2 4 2017
Building Permit Application Public War!.s
St. Lucie Cocroty, FL
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 APPLICATION FOR: Fuel
PROPOSED IMPROVEMENT LOCATI0111„ �;: , .� � � -
Address: 1 Z. T Z 7 ,AhA) L iA 4 ak ,u e).A �✓ /
Legal Description:
Lot No.
PropertyTax ID#: �����'� ® ® � d�/a
Site Plan Name: Block No.ls'
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED�pESCRIPTION Of"WORK
f�A C'Jct JPI y� LA.J 4-
CONSTRUCTION INFORMATION `
Additionalwor to e nerformed under this permit—cheCK all apply:
11HVAC 13 Gas Tank KGas Piping _Shutters Q Windows/Doors
0—El e*ctric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: o S .Ft.of First Floor:
Utilities:Sewer DSe tic Building Height:
Cost of Construction:$ .Sf�+ p i
01NNER/LESSEE t
ONTRACTOR
Name &Zfr
Name: Lany.Licastri
e ' as
. Am n
a 9
Company:
n .
Address:
C. •aN a P Y
City: IA4. �
a '� State: —L Address: 3301 Oleander Ave
Zip Code: �'_L� Fax: City: Fort Pierce State:FL
Phone No. :2 YX Zip Code: 34982 Fax: 772465-8448
E-Mail: I Phone No. 772-633-0740
Fill in fee simple Title Holder on next page(if different E-Mail: Brian.Pearl@amerigas.com
from the Owner listed above) State or County License: 02707128579
If value of construction is$2500 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:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation ias indicated.
I certify that no work or installation has commenced prior to the issuance of a permit. i
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 covenantsthat 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
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
Z
ments to your property.A Notice of Commencement must be recorded and posted on the jobsite
re t fir ection. if you intend to obtain finan ' ,c Sult lender or an attorney before
men n k in our Notice of Commen ment
Signatur of Agent/Lessee a ure o ntractor/License Holder
STATE.O RIDA STATE FLORIDA
COUNTYOF COUNTY OF DTI L_V•cl-e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this� day of P9P .20� by this al day ofri 1 .201
by
LT- SIC O.S�
(Name ofperson a owledgin ) (Name of person ac owledging
(Signature of Notary Public-State o4l6rida) (Signatu of Notary Public-State of Frorida)
Personally Known X_OR Produced Identfflcation Personally Known�_OR '
Type of Identification Produ e .......
T)pe of Identification Produce �'' AMBER-L�DCZ
'• �'= MrY�,��MMiSSION tl FF956 45 '•: MY COMMISSION 4 FF956 5
Commission No. C)J`(o) E'7tP113ES February 01.20 Commission Now SlQIMS '• , ( ItEslFebruary o1.
,,,,. • 1407)394 0.53 FlordsNotm erme.mm
M0!5a nonds aww".00m
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW IREVIEW.
DATE
RECEIVED
DATE
COMPLETED
Rev.712014I
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