HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
4 f
- - - Building Permit Application
Planning and❑evelopmentServices
Building and Code Regulation Dfvtsian
2300 Virginia Avenue,Fort Pierce Ft 34M
Phone:(772)462.1553 Fax.(772)462-1.578 Commercial Residential
PERMITTYPE;
PAKI _ AWNx."�j s
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Address: ." _,
Property Tax iD#:4��� 3 bb��►-(:)I)U Lot No.
Site Plan Name: Block No.
Project Name:
-skfl.
kr. �.
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Additional work to be perform under this perrryt--check all that apply;
Mechanical Gas tarns _/Gas Piping Shutters —Windows/Doors
_Electric _PluTnbing Sprinklers _Generator Roof Pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_ utilities: Sewer Septic Building Height:
W - '•� '�!' =1n �". 11 ` N - ? 1 .t 1 Jn
1l1 lL L h y �
Pi1f 1,1V'Kll �...-yR C:'Nrt Y.! 3H)l+r�siel r�
Name Name.Larry Licastrl
Address ' b D"L (J Company:AmeriGas
City ) GN1/` State:�1_ Address-3341 Oleander Avenue
Zi Code
p• ILA D Fax. City; Fort Pierce State•1=L #
Phone Na. '�.P t- -t Zip Code: 34982 Fax 772-466-8448 €
E-Mall: LfV i 0 Phone N0772 633-074fl
Fill in tee simple Title Holder on next Age(if dllfFerent E-Mai[Arredeas-7262®amerigas.com
from the owner listed above) State or County I.icense027€ T128;a79 j
If value of cons %kdan is$2500 or more;a REG4RaED Notice of Commencement is required.
if value of HVAC is$1,500 or more,a RECORDED Notice of Commencement Is required.
44
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: r__._NotApplicable
Name: Dame:
Address: Address:
City: .- State: CRT, - _ State: i
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: City..
Zip. Phone: zip: Phone:
OWNER/CONTRACTOR AFIFIDVIT;Application is hereby made to obtain a permit to do the work and Installatlon as indicated.
I certify that ncr work or Installation has commer=d prior to the issuance of a permit.
St.Lucie Counttyy makes no representation that Is grant rig a permit will authorize the permlt holder to build the subject structure
which Is in conflict with anypplfcable Borne l3wnersociation rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w your Nome 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 Rarida Building Codes and St.Lucle County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO.OWNEM Your failure to Record a Notice of Qrnmenceme result In your paying twice for
improv qtm roperty.A Notice of Commence tm arecond posted on the jobsite
befo theinspect o if you intend to obtain financl Gansu t lith lender r an attorney before
w rTeco Itt rloEFci'-of~�erte �I - - -
Signatu a of O r essee/Contractor as Agent for owner S nature of Co tractor/License Holder
STATE 0 10 STA RIDA
t�OtINTY OF tiI`f�v COUNTY OF �[�✓
The Ing instru was acknowledged afore me The for bag Instrument ulna acknowedged b #ore me
this r �day of h . .2l}� by this . day of- -�c,� ,Zp,��y
l �L�,V1 1 L i c -- . ,rY i
Name o#�on Maki statement Name of ersoSmaking statement
Personally Known R Produced lderrtification Personally Known OR Produced Identification _.-
Type of identiflutlon Type of Identification
Produced A Produced,
_ I
(signature of Nate
`(Signatu of Nola public- of Florida)
! „,Ypu,, KRIS?lE KIFlB`r" 4E KIRBY
:� . Commissli2n No. ,,
4pn3mi55ian No. =o - otary p(Siecyl}state of Fiori::a Notary Pub c State of Florid
*= Commission #GG 92537E
My Commis icr Ex�i es .= Commission#GG 926370
^3 2G23 commission Expires
October F
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i
RECEIVED _ 1
DATE
Rev.8/2/17