HomeMy WebLinkAboutTREFELNER-PERMIT APPLICATIONAll APPLICABI INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da__ I'1_ - _ Permit Number,
Building Permit Application
Planning and De vetopment Services
Bulldtng and Code Regulation Dlvts bri
1300 iftinla Avenue, Fort Pierce FL 349U
Phone: (7721462.1553 Fax: (772) 462-1578 Commercial Residential
i PERM{TTYPE:
Address: [y t_ U
Property Tax la #: 1 - _ vD 0 b b 5r Lot Na.
Site Flan {Name: 0, tKN Block NO. -- _
Project Nairn:
Additional work to be performed under this permit -check all that apply:
,_,,,Mechanical _-Gas Tank ,_6as Piping _ Shutters � Windows/Doors
— Electric ^ Plumbing _ Sprinklers - Generator — Hoof .Pitch
Total Sq. Ft of Construction: Sq. Ft. of First. Floor:
Cost of Corlstructlon: $ ff�-/ _ l Ui� 1 t' Utilities; „ Sewer —Septic Building Height -
Nam
e L v x '
Address: 1D D L � 7_ t'1
Clty: i 4e/V u State.
Zip Gode:S L_I_� L i X Fax;
Phone Na. 11_t-
E-Mail:
till in fee simple Title Helder on next page ( if different
from the diner listed above)
Name;Larry Licastrl
Company:AmerlGas y
Address:3341 Oleander Avenue
City: Fort Pierce State- FL
Zip Code: 34982 Fax: 77246641448
Phone No772-633-0740
E_Mai l AmeriGas-7262®amedgas.com
State or County UcensQ02707128679
if value of constWation Is $2500 or more, a RECORDED Notice of Commencement Is required.
If value of hVAC is V,500 or more, a RECORDED notice of Commencement is required.
DESIGNER/ENGINEER: — Not Appiica
Name:
Address:
City; State: -
Zip: Phone
FEE SIMPLE TITLEHOLDER: Not Applicable
Name;
Address:
may.
ZIP: Phone:
MORTGAGE COMPANY: Not Applicable
Name;
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Addrest:
city:
Zip, Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and iristaliation as Indicated
I certiry 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 cofsflict with an � appilcabf a Horne Owners Association rules, bylaws ar ancovenants that may restrict or prohibit such
structure. Please consult w th your Home Owners.Asaoelatran and review your deed r any restrictions uvhle may apply.
In consideration of the granting of this tequested permit, I do hereby agree that I will, In all respects, perform the worts
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: roots additions,
accessory structures, swimiming pools, fences, walls, signs, screen rooms and accessory uses to another nonresidential use
WARNING TO. OWNER: Your failure to Record a Notice of
irnpprov nts roperty. A Notice of Comrnencl
befo the s inSpeCtIO if you Intend to obtain finan
Agent €or Owner
STATE 0 R1D.
COUNTY, I InI G� i� V-�✓
Tits forgoing instrugent was acknowledgl before me
this D� day of ✓ 261-k by
[tame of pars_ ongaking statement
Fersonally Known �: OR Produced Identification
Type of Identification
It In your paying twice for
and posted on theJobsite
pr an attorney before
of
The fip�oing instru nt was acknovAedeetl I afore me
this { ►day of . jj Vi 20` by
Name of pia making statement
Personally Known OR Produced Identification
Type of Identification
I (Sign f ture of notary stgrMUre or•riarary ruouo- t
+�_, KR STIE KIRBY K IST72_
;Y �'',,
Commission No.=�:NOtar tic -State of Florid Y ;<iptafy mmissiim Na, ,*� a
Commission ft GG 925370 ,}
"` My Commission Expires
Commissio
�%�,°•",.` October 23, 2023 ��,��A? My Comm
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REVIEWS FRONT E ZONIM SUPERVISOR PLAINS VEGETATI A TURTLE MANGROVE
COUNTER !REVIEW REVIEW REVIEW REVIEW REVIEW I REVIEW J
Rev.8/2/17