HomeMy WebLinkAbout11652 ORANGE AVENUE PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Qate:
Permit Number:
Building Permit Application
Planning and DevelvpmentServices
Suflding and Code Regulation Dfvislon
2300 Wrglnia Avenue, Fort Pleme Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
ReSidentlal_
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Address:. ;` l to , L cjr-hn�e- Z.t �-")d�
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Property Tax iD ##: z -I C3 OQOO OOC� / Lot No.
Site Plan Name: TLI- Block No.
Project Name:
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Additional work to be performed under this permit-- check all that Apply:
Mechanical .XGasTank �as Piping _ _Shutters r wWindows/paors
T Electric _ Plumbing Sprinklers Generator Roof —.Pltch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 9_}C - 06 Utilities: —Sewer _Septic Building [eight=
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a�h�i�r�
Name•Larry Licastri
i
Name i';-J�r,
Address: Z01 "m, ebe i i J _
Carnpany:AmerlGas
-ity: EgE - e.a -te—, State:
Addresss330t Oleander Avenue
Zip code: 221 Fax:
City: Fort Fierce State: FL
phone No. L - �P
Zip Cade: 34982 Fax: 772-465-8448� I
EWail:
Phone No772-633-0740 }
Fill in fee simple Title Holder on next page ( if different
E-Mail AmeriGes-7282@amedgas.com
from the Owner listed above)
State or County Ucense027D7128579
if value of construction is $MO ormore a RECORDED Notice of Commencement is required.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
7r
�Applicabie
DESIGNER ENGINEER:
Not
MORTGAGE COMPANY.
NotApplicable
Narne:
lame:
Address:
Address:
City.
State. _ _ "
City:
State:
Zip: Phone
dip: Phone:
FEE SIMPLE TITLE HOLDER:
_, Nat Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name--
_
Address:
Address: _
City:-
City-
ZIP:.. Phone-_
Zip: Phone:
OWNER/ CDNTRAC'i'OR AFF IDVIT. Application is hereby made to obtain a permit to do the womand tnstauation as inaiGaceo.
i certify that nowork or installation has commenced prior to the Issuance of a permit.
St, Lucia County{ makes no repr entation that Is grautting vomit All authorize the permit ltolde to buiid the subject ss�tructure
which Is in contiict with anUg bie Horne Owners s atlon ru All bylaws ar an covenants tflat may re trice or pro such
6triicture. Please consult w your Horne Own�rs.AssocWon and review your dead r any restrEcttans wh may apply.
In consideration of the granting of this tequested permit, I do hereby agree that I will, in all respects, Perform the work
In accordancewith the approved plans, the Florida Building Cedes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a fug concurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessary uses to another non-residential use
WARIM MG TO. OWNEW Your faliure to Record a Notice of
ImpraoX .mpnts . roparty. A Notice of Commence
beta the s inspe o if you intend to obtain financ
as
iit in your paying twice for
and posted on the jobsite
Apr an attorney before
Holder
STATE 0 IDA a<IAI V t,pei, n1Uft
COUNW OF ti L V {� I COLT NTY OF k Cat (,!A -
Tli(jjfp going—da iostrti LA a � Iby re me
thl��day of �^-'�
I .('/vL.; [J,; it SkYI - -
Name dFWsgq)w i; statement
Personally Known OR Produced identification
Type of Identification
Produced
Cpmmission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED _
Rev. 8/2/17
The
this �Ing Instrain�a eeknowiadgasl before me
.�J11 _ Zp_ by
LICti S�I'y+
Nance Of perso�akIng statement
Personally Known OR Produced Identification
Type of Identification
Produce .
All �
gnatu of Notary Public- state of Florida I
K IISTIE KIRBY
tart' p,(agaostate of Florida Commission No. IE KIRBY
ommission N GG 925370 SJotary Public -State of F
My Commission Expires I,
1�, ln_ Commission # GG 925
COUNTER I REVIEW � SUPERVISOR REVIEW I REVIE{ii!- [ � REVIEW