HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z67 r Permit Number:
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Building Permit Application APB 20V
Planning and Development Services
Building and Code Regulation Division p u�,a i c wort{s
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie C o u n ty, L
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential.
PERMIT APPLICATION FOR: Fuel
PROPOD,IMPROVEMENT
SE
Address: 13 410 11/1d JAW /awl 42'mr'�
Legal Description:
Property Tax ID#: ��/r.76�' �® O®.T,,/_ Q00--I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION`OF WORK 't ,
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rCONSTRUCTION INFORMATION
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Additionalwor to bnerformed under this permit—cheGr.d1l apply:
DHVAC Gas Tank &as Piping —Shutters 0 Windows/Doors
❑Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Utilities:.Sewer Septic Building Height:
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OWNEJLESSEE � ;.��__ _. ..., .� -- -
ONTRACTOR �
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Name S PA e_1 Co
l Name: Larry Licastri
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Address: Company.
Ame9as
n
City: State: C>� Address.
3301 Oleander Ave
Zip Code: r7f d3 7 Fax: City: Fort Pierce State:FL
Phone No. -7 2 44 S- TT6- Zip Code: 34982 Fax: 772-465-8448 �
E-Mail: 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: 02707/28579
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:i Not.Applicable MORTGAGE COMPANY., . Not Applicable
Name: Name:
Address: Address: I
-- City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name:" Name: i
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 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
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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 I 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 I STATE FLORID
COUNTY OF S . Luk c COUNTY OF L�CI
The for o m ing instrument was acknowledged before me The forgoing instruent was acknowledged before me
this day of ADrl'{ ,20 TI by this QI day of AOri) .20—n by
Lv.r Uc' +T LQr l,ic i I
(Name of perso knowledgin ) (Name of pers acknowledging
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known _ rsonally Known_O .
Type of Identification Produ a AMBER L DIAZ T1 pe of Identification Produ cl•'ie'' AMBER L DIAZ
:r MY COMMISSION N FF968 4S '_•: '•i MY COMMISSION N FF9561
Commission No. l45 tSs�fles February 01.20 C mmission No. „ , ES February Ot.202
4407)306 0153 FlondeNOWOOMMACM (40709B0•S3 FWONutw vrvwwcoom
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE'
COMPLETED
ev.712014
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AM;.