HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED of
Date: L Permit Number: ® 1
Building Permit Application
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 111%IPROVEMEyNT LOCATION _,'�� ' �zY � - ;
Address: 1 ; !q 13 M W We-&, .fig N eA
Legal Description:
Property Tax ID#: .41143 G"4C C9t—'0070? - p o o-.S' Lot No.:_
Site Plan Name: Block No.
I
Project Name:
Setbacks Front Back: Right Side: Left Side:
4 fly
DETAILED DESCRIPTION' ?F WORK
F Sy
,CONSTRUCTION INFORMATION � f `
Additional work to De-performed un er t is permit-check all a p p y:
11HVACk.-�t_G_as Tank. ®Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 'v- +��s Utilities: _Sewer[]Septic Building Height:
01NNER/LESSEE � � - CONTRACTOR _ _ _
Name tf 414 0 s1? te, Name: Lary Licastri
Address:7 7.&o AA&dnt K ?)&-_J Company: Amerigas
City: 2 /�,"hr State:,FL Address: 3301 Oleander Ave
Zip Code: 3 "l �O Fax: City; Fort Pierce State:FL
Phone No. `18S-3o� f Zip Code: 34982 Fax: 772465-8448
E-Mail: Phone No. 772-633-0740
Fill in fee simple Title Holder on next page(if different E-Mail: Brian.Pead@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: 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:
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
e
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 men'
Signatur of Agent/Lessee a ure o ntractor/License Holder
STATI O RIDA STATE FLORIDA
COUNTY OF S'f'. LUU2 COUNTY OF S�, Wfa,t
The fo oing instrument was acknowledged before me The fo oing instrument was acknowledged before me
this day of 20�by this day of 1111 20-1 by
L�Cfll ri l,Gl LI�CGISAr
(Name of person knowledgin ) (Name of person ac owledging
01
(Signature o Notary Public-State of Flo ida) (Signature of Notary Public-State o Florida)
Personally Known X OR Pr Personally Known X OR Pr p 1 entl
Type of Identification Produced AuFtog i ni ZffType Identification Produce =
56
ap,
MY COMMISSION 0 F 956145 ES February 01.20Commission No. a JXpIRES February0 ,JaMm ssion No. 01%%45 ( !?�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2034