HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONW,
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ALL APPLICABLE I FO MUST BE COMPLETED 1`01' APPLICATION TO BE ACCEPTED
Date: '7 Permit Number: k3- Q
SCANOED RECET1��n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
it Application I MAR 0 6 2018
ST. Lurie County, F
I Residential
PERMIT APPLICATION FOR Fuel
PR"OPOSD IMPROVEMENT LOCATiO.NY Y
Address: '� % C7 Y ra.1 has 4f % �
Legal Description:
Property Tax ID #: 1 S u( -ti JJ —Dob O ~vim//
Site Plan Name: I
Project Name:
Setbacks Front- Back: Right Side
FAY 25-cc iy�/� .. e4u
under tnis Dermit —
11HVAC Lq_1 Gas Tank ®Gas Piping
11 Electric 0 Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
a Left Side:
apply:
Shutters
Generator
S . Ft. of First Floor: _
Utilities. y' Sewer FSeptic
Lot No.�5'_
Block No.
QWindows/Doors
❑ Roof
Building Height:
OWNER/LESSEE_ � i"
NT (� '
Name 5U l�`1� Gl� �F��
Address:_'?I64 iG,fia eJ��� �'(i� —
Name: Larry Licastri
Compalny: Amerigas
City: !� -j�TP State:
Zip Code:.3q !2 U Fax:
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Phone No.
Zip Code: 34982 Fax: 772465-8448
E-Mail:
Phone No. 772-633-0740
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: E9dan.Pearl@amerigas.com
State or County License: 02707/28579
If value of construction is $2500 or more, a RECORDED Notice oT LOmmencemeni is requirea.
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DESIGNER ENGINEER:
Not -Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
I
City: State:
City: I State:
Zip: Phone:
I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:'
I
Name:
Address:
City:
Address: I
City:
I
Zip: Phone:
Zip: Phone: I
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OWNER/ CONTRACTOR AFFIDViT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify 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 conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested 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: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result In your paying twice for
im ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
fore t fir�iii7ection. If you intend to obtain finan , c, c suit Mender or an attorney before
.`.t�.�.��....-.�...�I.�nF('nmmunM�nt�
I
Signatur of Agent/ Lessee I
I
a ure o ntractor/License Holder
STATE O RIDA �l
I
OFORIDA S�` 1 9
COUNTY OF T ,C)
COUNTY
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of . 20 by
this day of . 20_ by
arm
(Name of.person ackno edgin ) I
(Name of person ackno edging
(Signature of Notary Public- State of Florida)
(Signature of -Notary Public- State brFlorida )
Personally Known x OR Produced Identification)
Personally Known k OR Produced Identification
Type of Identification Produced I
Type of Identification Produced
Commission No. 61 "' (Se BER L DIAZ
,.� r ag R L DtAZ
mmission No. l=�Q "�' :z MYS MISSION A FF9561
'': •'= My COMMISSION q FF9561
5 'A EXPIRES February 01. 202
�,.
• .• ebruary 01. 20 0 0 ,13he 0•53
REVIEWS FRONT 140 `"
LANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
(v
DATE
COMPLETED
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