HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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•
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 TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: -14 20 . r,� 40
Property Tax ID#: i102:L? S Lot No.
Site Plan Name: - /I')obi I� G nef e- Block No.
Project Name: - N e- 7� -
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION-
Additional work to be performed under this permit-check all that apply:
_Mechanical /V Gas Tank ,'Gas Piping _Shutters T Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 60/rw,`.t11,' .bn . Name:Larry Licastri -- -
Address: RCP( qv3Sqq Corn pany:AmeriGas
City: M-I c,n State:h Address:3301 Oleander Avenue
Zip Code:_ 3l ti 3� Fax: City: Port Pierce State:FL
Phone No. OS- - Z Zip Code: 34982 Fax: 772-465-8448
E-Mail: Phone No772-633-0740
Fill in fee simple Title Holder on next page(if different E-Mail AmeriGas-7262@amerigas.com
from the owner listed above) State or County License02707/28579
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
TP
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: �Not Applicable
Name: Names
Address: Address:
City: State:— — City: Stater
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _,Not Applicable
Name. _ Name:
Address: Address.-
CRY. - - - - City. - -
Zip: _Phone: zip: ,r, Phone:
OWNER/CONTRACTOR AFFIOVIT:Application is hereby matte to obtain a permit to do the work and instapation as Indicated.
I certify that na work or Installation has commenced prior to the issuance of a permit.
St.Lucie Counttyy makes no representation that Is grant ng a ermlt win authorize the permit holder to build the sub act s'trueture
which is In conflict with any�ppOtable name Owners s tlon rules,bylaws or and covenantsthat may strict r prohlbit such
structure.Ptease consult w7ih your Horne Owners Association and review your deed for any restrictions whl may apply.
In consideration of the granting of this requested perrmit.I do hereby agree that I will,In all respects,perform the work
In accordance with the approved plans,the Florida Building Cedes and St.Luale County Amendments.
The following building permit applications are exempt from undergoing a frill concurrancy review:room additions,
accessory structures,swimming pools,fences,waits,signs,screen rooms and accessory uses to another non-residendal use
WARNING TO.OWNER:your failure to Record a Notice of Commenceme result In your paying twice For
lmpprov nts roperEy.A Notice of Commence t m a recur and posted on the Jobsite
befo the s inspectto if you intend to obtain financi con su t I lender r an attorney before
silinatu a of r essee/Contractoras Agentfor Owner 5 nature of Co victor/License Holder
DA
COUTE 0NTY OF - G.v1 V U✓ COUNTY OF ��i lstc..-� �?/L y�•
The Toing instru t was acknowiedtd before me The r oing instru ent was acknowled b fore me
this�`�day of 2t?4J by this�day of., .20 y
Name cN person rig statement Name o perJcs a rl�aking statement
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Type of Identificatlon
Produced Produced.
(Signatim of Rio (Signatu o T
�r"' K�j�E KIRBY KRISTIE 6!8 Y
Commission No. :+'" &4" A Comrnl$sEan c•�'+�" •;f',
Co
State of Flaride ubiic•5t _ Florida
Cammlaaion 40 GG 826370 2+ Qd Commission M CMG 925370
MY Commission Expires = � My Commlaslon Expires
REVIEWS FRONT PLANS MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW 1
HATE i }I
RECEIVED
HATE
COMPLETED
Rev.8/2/17