HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/28/2017 Permit Number: — %2(o' .
2FD
Building Permit Application
MAC 2 9 201-71
Planning and Development Services PERMITTHNG
Building and Code Regulation Division St. Lucie County, ,=L
2300 Vieginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Gas tank
PFtOPO5ED IIV{PROUEMENT LCATIC3IU
Address: 7671 CHARLESTON WAY
Legal Description:
Property Tax ID#: 3321-801-0639-000-6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
RTAILEd`l7ECRIPTION OF WORK 4 P
k a
Set aboveground 200# laydown (58 gallon)tank run line to BBQ.
CCINSTRUCT ION'
INFORMATION
Additional work to b e e orme under this permit-c ec a apply:
11HVAC ICJ Gas Tank ❑✓ Gas Piping _Shutters �Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ \�Ob UtilitiestSewer OSeptic Building Height:
UIIVCVERjI.ESS3EE �.. `f CONRACTOR� y
. ,
Name Michael W Dacey Name: Larry Licastri
Address:7671 CHARLESTON WAY Company: AmeriGas
City: Port St Lucie State:FL Address: 3301 Oleander Ave
Zip Code: 34986 Fax: City: Fort Pierce State:FL
Phone No.772-465-7886 Zip Code: 34982 Fax:
E-Mail: Phone No. 772-633-0470
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.
'�I $•.S�' i-t 'I �_, .._c :' r a f .. c} try i, 4 y�i,.^r t r. a�
d a i s c $,.r+. ci#�
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DESIGNER ENGINEER: Not.Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:
City: State: ty:
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 Association rules,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 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
impXwgments to your property.A Notice of Commencement must be recorded and posted on the jobsite
fore t fir ' ection. If you intend to obtain finan ' ,c suit i lender or an attorney before
men n k ing your Notice of Commen ment
Signatu=.ORIDA
gent/Lessee au re o ntractor/License Holder
STATE STATE FLORIDA
COUNTY OF kkC-12 COUNTY OF 5'4'• Ludt Q
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 22day of /i'Zo�C ,200 by this Z%7 day of�4J,,n aeA,e_ .20a by
(Name of persona owledgin ) (Name of person acknoW ledging
Si nature of Notary Public-State of Florida (Signature of Notary Public-State of Florid
B )( ry
ER L DIAZ
Personally Known OR r Pers ally Known�_O ,IdentcoMas�s56
lo Type of Identification Produced ;'�"�"I4:: F pe f Identification Produce Y pyio
of 2020 EX� .�v.».c«�
Commission No.PF 150145 , •ewl. Pebn+e� Com ission No.V:IM51a145 S
3s u'53
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.772014