HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: .� Permit Number: JDas
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 +rAn j:
POSED IMPROVEME LOCATION 3
PRO
NT
Address: 14 001 Qa y AA-t r ®e J- le,
Legal Description:
Property Tax ID#: 2.41 Z9 — 23 o 00®r— oll Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK x 4 � u ,
- '1 - ?' -d £.ti .1 K _ � 4 ' !✓a ( fink.
�' �►' n®��a� . b�'� saw �ry ►c �,�� &_p4al oever /#^n es �Lo M eW -r44y 140J
ZvL,CONSTRUCTION INFO_ RMATION '- - `
rtiona wor to e e orme under this permit_c ec a apply:
F]HVAC V Gas Tank RGas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ .1Z0®, -� Utilities: Sewer 0Septic Building Height:
OWNER/LESSEE .> Y=
CONTRACTOR
Name ZI y o G Zee,jt-hf Name: Lary Licastri
Address: q(201 ep" , t ll Company: Amerigas
City: Tbe-, ' .4 ce State: Address: 3301 Oleander Ave
Zip Code: 3 an KI Fax: City: Fort Pierce State:FL
Phone No. :3 1 T IVY D ®%Ili 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.Peari@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.
AML
may( IS' 4. �'a•,3� - '` $..c-•Ya `} �[t "f �r. iVKm
DESIGNER ENGINEER: Not-Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
-- City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: Nat 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 Coun 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 Horne 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 suit 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 II '' 11��,,''1 STATE FLORIDA
COUNTY OF S�c Lh�l�, COUNTY OF T t
The forgoing instrument was acknowledged before me . The forgoing instrument was acknowledged before me
this day of AMU.U ,26 1 by this day of 20i_1 by
(Name of person c nowledgin ) (Name of person ad&wledging
off
(Signature of Notary Public-State o Fio ) (Signature of Notary Public-State Florida)
Personally Known _ rsonally Known _ lutH
Type of Identification Produ AMBER L DMA ' T pe of Identification Prod u `'•`�
�•;' •= MY COMMISSION N FF9fi �S =_': ••E MY COMMISSION li 1d
Commission No. 14 ( ;ES February Ot,20 0C mmission No. F EpS February 01.2020
1407;33900•53 FWdaN0WySamae.com .4071 0'S3 Flonda niVa7d.W111
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.772014