HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL AF
Date:
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Permit Number: L DV�Q • 00�04
�%Pnlv
By
W,1019^1111+
Building Permit Application
Planning and Development Services .
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Gas tank
F:ROPoEo 11111PRO1/EMENT LOCgTItN
A7unoZ) aionl IS
3uaLu4jedeQ 6u1111wa9d
Blot z f 1qnr
43/1I3J3M .
Residential X
Address: 9710 Russos Rd
Legal Description: 3 34 39 SE 114 OF SW 1/4-LESS W 330 FT AND LESS TRACT 250 FT X 206FT IN SE COR AND LESS E 70 FT AND LESS S 25 FT- (26.65 AC) (15) (OR 3877-1385)
Property Tax ID #: 1303-341-0002-000-5
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
Bury 500 gallon propane tank run line,to tank less water heater, pool heater and house stub. Run
Inside lines to stove, Dryer,.future BBQ and 2nd tank less water heater.
Total Sq. Ft of Construction:
�v
Cost of Construction: $ 2 q 10-" -
S Ft. 'of First Floor:
Utilities:Sewer Septic Building Height:
O_.,t�R
�..6.,
ti=
h �S L'� `5, P �'. 5 fi.ei`F4�":Ay �Mae5j3
Name Eric Leonhard
Name: Larry Licastri
Address:4307 Metzger Rd
Company: AmeriGas
city: Fort Pierce State:FL
Address: 3301 Oleander Ave
Zip Code: 34947 Fax:
city: Fort Pierce State: FL
Phone No.
Zip Code: 34982 Fax:
E-Mail:
Phone No. 772-465-7886
Fill in'fee simple Title Holder on next page (if different
E-Mail: Brian.Pearl@amerigas.com
from the Owner listed above)
State or County License: 02707
If value of construction is $2500 or more, aRECORDED Notice of Commencement is required.
NEER: (/ Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _AJ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: -/Not Applicable
Name:
Address: '
City:
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 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
imMthee
s to our property. A Notice of Commenceme st ecorded and posted on the jobsite
bes ins ction. If you intend to obtain financi g, cons ith der or an attorney before
co o record ine our -Notice of CommenC nt.
Si re of Ow ee/Contractor as Agent for Owner
Signat re of Con ra or/License Holder
STATE RIDA
STATE FL IDA
COUNTY OF S\- l�c��
COUNTY O
The forgoing instrument was acknowledged before me
this `t day of 20A by
The forgoing instrument was acknowledged before me
this —1 day of 20_1%_ by
C ck-x-c- v Lcc�S�c�
Name df person making statement
Personally Known X OR Produced Identification
Name of person making statement
Personally Known >< OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- a )rld@taPublic State of Flc rid
a ry
Angela M Boore
e (�p mission GG 19G60�
Commission No. t� � ovr� Eu 'fires 02/27/2022
( gnature of Notary. Public- Stat o F �11a C
Notary Public state of
Bela M Boore
C mission No. 1 eUCommission GG 1P Expires 02/27/2022
4,�
u
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17