HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC BLE 11UCh MUST BE COMPLETED FIOR APPLICATION TO BE ACCEPTED
Date: �` 0 I
�SGANNED
Permit N umber:
. � By RECEIVED
uriP
- Building Permit Application MAR 2 3 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort PierceFL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 .Commercial _ Residential
PERMIT APPLICATION FOR: Fuel
PRO.POSEQ. {,MPROVEI�II��IT L��G
Address: Q
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: 1
Front 1� Back: �_ Right Side: Left Side:
Setbacks
Lot No. (4 T L�
Block No. a
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0,0d Tun
I'arlc� and S--tbou� -t mny),C JCt_s
itiona wor to a erformed under tnis permit — cr
1jHVAC loGas Tank Elas Piping
11 Electric 1:3 Plumbing Sprinklers
Total 54. Ft of'Construction:
Cost of Construction: $
0 Shutters a Windows/Doors
ElGenerator 11 Roof
Sq. Ft. of First Floor: _
utilities: Sewer Septic
Building Height:
Name,\ Yf-f
Address: \`laVD N th 5�
Name.: Larry Licestri
Company: Amerigas
\ f C� State: g
Address: 3301 Oleander Ave
City: s�
Zip Code:3 Fax:
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No.
Phone No. 772-633-0740
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail: Brian.Pearl@ame0gas.com
from the'Owner listed above)
State or County License: 02707/28579
If value of construction is.5z5uu or more, a KrP-vnvr.+ 11uuMo ■••r•�••• - •••- - - �Y-•• -•
°FSUPPLEM'ENTAL.CONSTRUCTI'ON-LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: -
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 such
prohibit
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
improvements to your p operty. A Notice of'Commencement must be recorded and posted on the jobsite
befor the first inspectibq. If you intend to obtain financing, con It with lendeJr an attorney before
com ncin work or r rdin ur Notice of Commencement.
Signa re of, ner/ Lesse Contractor as Agent for, Owner
Signat e f Co tract r License older
COUNTY 0 STATE OF F RIDA S? ��
ORID
COUNTY OF
The forgoing instrumen as acknowledged before me
'1 1A
The forgoing instrument was acknowledged before me
this day of 20by
this—3&?day of f -A&Y1-/Ci 20JS by
L
L-0 4AA4 ctA I#A
Name of persomaking statement
Name of eryn making statement
Personally Known // OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nota . Pulg4aII u+ t,� of FI&MM HER
`o�Pa ° •-, State of Florida
(Signature of Not
ALICIA RNANDEZ
Notary Public
�a* + = # FF 898635
Commission No. * •= Comifmop
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� SPRY PUBG �.
Commission No. :a°* �; Notary Publ'j�eS� to of Florida
� �F 898635
My Comm. Expires Jul 13. 2019
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''� Bonded through National Notary Assn. '`
:. # # •= Commission
-
: P, * o My Comm. Expires Jul 13, 2019
i,
Ronded through National Notary Assn. '
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED -
DATE
COMPLETED
REC
IVED
Rev. 8/2/17
MAR 3 0 2018
ST. Lucie County, Permitting