HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
APPLICABLE I MUST BIEWOMPLETED. FOR APPLICATION TO BE ACCEP
Date- Permit 11 umber:
SCANNED
BV
BdildIRA? it Application pbrm/tti,7 .1.9 20
18
Planning and Development Services St. 4U _q oepatN
Building and Code Regulation Division C/e cotnty e,)t
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
I PERMIT APPLICATION FOR: Fuel
Address: gi (3
Legal Description:
Property Tax ID #:
site Plan Name:
Project Name:
Setbacks Front__AID Back:
UHVAC Ly Gas Tank
11 Electric 0 Plumbing
'Total Sq. Ft of'Construction: —
Cost of Construction: $ 0237 /.
C.
Right Side: V (:) _ Left Side: E 11Q)
Y_ n
r tnis permit —
NMas Piping i isnutEers
]Sprinklers 11 Generator
S Ft of First Floor:
Utilities. Sewer OSeptic
Lot No._
Block No.
E]Windows/Doors
11 Roof
Building Height:
Name
5'.
Name. Larry Licastri
Amerigas1
Company:
Address: ink D,;4e- ��
city: pvk: vieno-state: FL.
Zip Code: _ Fax:
Phone No.
E-Mail-
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 172465-8448
Phone No. 772-M-0740
E-Mail: Brian.Pearl@amedgas.com
State or County license: 02707/28579
If value of construction is $2500 or more, a Kr1_UKLPCLP Imutl6c up .......
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MORTGAGE COMPANY:
s`"'v�^^Y..
, Not Applicable
DESIGNER ENGINEER: _ Not.Applicable
Name:
Name:
Address:
Address:
City:
i State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: —
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
!
City:
Zip: Phone:
Zip: -Phone'
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inct icatea-
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conAct with anyr 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
11momw,ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
fore tq fir ection. if you intend to obtain finan ' ,c�
Rsuit I Ilender or an attorney before
.... ��..� r �nr.,r.iino vnr Nntiro Af r'nmmPnlQ[irMPtltJ �
Signatur of Agent/ Lessee
a=ontractor/License Holder
STATE O RIDA
STAIDA
COUNTY OF cSX- � �
COUNTY OF Sic l%,:&
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this %Ss day of t!)"* . 20 t`b by
this IS day of P f' . 20! by
(Name of.persoh acknowledging) !
i
(Name of persdn acknowledging
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known_ OR o c d d ti t'
_�_
Type of identification Produc !
,fie of Identification Produce
ev Notary Public State of Ficrids
tqO * . ( la M Boore
., s° a M Boore
Commission N 1 O (� 8¢ mission GG 190609
Commission Now
o mmission GG 16GF iG
s Expires 02/27/2022
0, Expires 02/27/2022
ova
,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
KeV. //LU14