HomeMy WebLinkAboutDONAVAN-PERMIT APPLAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:,-„_ U I,, Permit Number:
Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
230014rgiala Avenue, Fort Plena FL 3402
Phone. (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE; V�V p a,,,
Address:
U
PropertyTax ID #: �� D O , U Lot No.��
Site Plan Narne: Block No.
Project Name: D 1n (, V 4"-N
Additional work to be Performed under this permit, check all that apply:
_Mechanical ,,,,,Gas Tank —=Idas Piping _ Shutters Windows/Doors
T Electric _ Plumbing Sprinklers Generator Hoof Pitch
Total Sq. Ft of Construction: Sq. R. of First Floor:
'Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
city VD YT - S State:
Zip Code: � Fax:
Phone No. _ - 10 1.D_ 41
E-Mail:
Fill In tee simple Title Holder on next page ( if different
from the Owner listed above)
Name;Larry Licastri
Carnpany:AmeriGas
Address•3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Cade: 34982 pax. 772-465-8448
Phone N0772-633-0740
E-MailArn rdGas4262Qamerigas.00m
State or County Llcense02707f28579-
If value of Construction Is 52SOO ar more. a RECORDED Notlee of Commencement Is reanimd.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
DESIGNER/ENGINEER: Not Applicable
Name:
Address -
City, State,
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Zip: Phone:
MORTGAGE COMPANY: � Not Applicable
Name:
Address:
City: State:
ZIP: Phone:
BONDING COMPANY: __Not Applicable
Name:
Address.
City: .. - ... .. - -
Zip: „_ �,�, Phone•
OWNER/ CONI'TRACrOR AFRDVIT: Application is hereby made to obtain a permit to do the work and installation as Indicated.
I certlk that no work or Installation has commenced prior to the Issuance of a permit.
St. Lucie County manes no representation that is gran#�ng�rmit will authorize thepermitholder to build the subject 5tt'ttcture
which is in con itt th awJpplirabie Borne Ovuners �s permit
rules, bylawsgr and covenants that may rgrict or prA It iruch
srructure. Please conSuit w your Horne Owners Association and review your sed for any restrictions whi may appty.
In consideration of the granting of this requested permit, I do hereby agree that I will, In all respects, perform the work
in accordancewith the approved plans, the Flo'riaa Building Codes and St. Lucie County Amendments.
The failoyAng building permit applications are exempt from undergoing a full concurrency review. room additions,
accessory structures, swirriming pools, fences, wails, signs, screen rooms and accessary uses to another non-residential use
WARNING TO OWNER: Your fallure to Record a (Notice of 1
imppra� nts roperty. A Notice of Commence
bc�Fa the inspec# o If you intend to obtainnanc
as
STATE OF'Pt
COUNTY OF
The fn agtng Instrument was acknowledged before me
Ws , day of 4 /�L % e. 261-14 by
Name of p" making statement
Personally Known OR Produced Identification
Type of Identification
(Signature of NotaryKIRBY
CC)MMIsslon No. "YP� K�i�altate of Florida
tary P
Commission # GG 825370
My Commission Expires
REVIEWS
COUNTER I REVIEW
Rev.
*J 1
It In your paying twice for
and posted on the Jobsite
pr an attorney before
VON
The for aing instrument was acknowledged before me
this day of . M U VA .26 � by
Name of penon -making statement
Personally Known OR Produced Identification
Type of Identification
Notary Public -State
Commission No. 11"" . KF $WJE KIRBY
lkfs Notary Public -State of Florid
«- Commission # GG 925370
Octob$r 23,
SUPERVISOR { PLANS I VEGETA11
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