HomeMy WebLinkAbout2756 BROCKSMITH ROAD PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Bur7ding and Code -Regulation Division
2300 Virginia Avenge, Fort Pierce FL 34982
Phone: (772) 462-3553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential
PERMITIYPR:
rQ�E'LJ i 0.[3t!V C ?xRC1 _ -
L:--�
�-77
Address: Z'T 5 &9LkSn1-'Vn
Property lax IQ : 2 C - -501 - OCtoQ' - 000 - 6 Lot No. Q�
Site Plan Name: _ 1 hnL,' A. A ke. p1&�n _ Block No.
Project Name:
1w5f[� lci�t iNFRIA71',- e iJR. f ,
nr � S t-
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Additional work to be performed under this permit- check all that apply:
_,.,Mechanical Gas Tank XGas Piping
Electric Plurnbing _ Sprinklers
Total Sq. Ft of Construction:
'Cost of Construction: $ 6-1 - H _
_Shutters _ _ Windows/Doors
. Generator Roof -Pitch
.Pitch
Sq. Ft. of First Floor:
Utllltles: _Sewer ,.,_,Septic Building Height:
!Name a
Address: Z}S(o 5 rfl ' o)
City: _r 2�- . Pr a4tZ State: FL
Zip Code: 314 qqS Fax:
Phone No: ��Z �L� Y2 ` 91za -
E-Mali: --- -
Fill in fee simple Title Holder on next page ( If different
from the owner listed above)
Name;Lam L.lcastri
Company: Arne€iGas
Address:33Q1 Oleander Avenue
City: port: fierce - State: FL
Zip Code: 34982 Fax: 77246543448
Phone N0772-633-0740
E-Mail AmariGas-7262@amerigas.com
State or County Licerise'02707I28579
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
If value of t VAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
NER/5NGIN
Not Applicable
Name:
Address:
City, State:
Yip: Phone..,
FEE SIMPLE TITLE HOLDER: „_,,, Nat Applicable
Name:
Address:
City:
ZIP:,,Phone.
MORTGAGE COMPANY: _ Not Applicable
Name,•
Address:
CIS/: State:
ZIP: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
city._„ - - ---- .
Zip: Phone:
OWNER/ CONTRACTOR AFPIDVIT: Application is hereby made to obtain a permit to do the work and initailation as Indicated.
I cerdry that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie Counttyy makes no repr�#entat%tn that is granting a rxmlt 111 authorize the permit holds to build the subject structure
which is in oorriiict Krith an pp�icable Home Owners Association rues, bylaws or and covenants that may restrict rsr pro 1blt such
structure. Please consult w t� your Home ownersAssocl ation and review your deed for any restrictions whl 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 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, roam additions,
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-residential use
WARNING TO, OWNER: Your failure to Record a Notice of Commencem ej result in your paying twice for
Imppro�ts roperty. A Notice of Commence"'C.)Mn's
e reror and pasted an theabsrte
befr3 the s cnspectlo . If you intend to obtain #inanct ith lender ran attrsrney before
of own rj�essee/Contractor as Agent
STATE OP`t6R10A
COUNTY Of
The Ing Instrument wa acknowfedg before me
thIsMay of ��y
Name oPtersoking statement
Personally Known OR Produced identification
Type of Identification
(SignaturOft@Ie
commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
---- p! TIE KIRBY
Notar " C-Steto of Florid
crrtm�aaion # GG 926370
!1+iy Gbfi�rt9i�sibft Expires
re
STATEAIE,F. tRIDA
COUNTY OF 1 I �I /l�M � V�✓
The g ng Insir nt
as ac owledefore me
this y of .
2i7
;t C 4, &, v t
Name of pe
along statement
Personally "own
OR Produced Identification —
Type of Identification
`'T.A FV"KIRBY
Notary INWIc.. tit-, of Florida
..0 =lnis®Innt )025370
My Commission Expires
October 23, 2023
COUNTER REVIEW EGETAM
FRONT 7ONNG5 REVIEW � . REVIEW I PLANSV REVIEW
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REVIEW �EViEW