HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,ALL APPLICABLE INFO MUST BE COMPLETED. FOR APPLICATION TO BE ACCEFrED Date:. / Permit 0 umber: I Q 0(D -01Sq 3
RECEIVED
DIV o��i�n11111Vt�!
JUN 15.2018
IQi#.rmi Applicalion Permitting D
Planning and Development Services St. Lucie countyent .
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR Fuel
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Address: 5
9
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Legal Description:
Property Tax ID #: -WOZ Col ' 07,60—O —8- Lot No. H 7+y&r
Site Plan Name: Block No. 20
Project Name:n
Setbacks Front Back: /O Right Side: I �Q Left Side:
p.E`Tar��a t��scr��i��r�0����=�N¢�K � � : z� �• v = , , rT "^�# ��, 2r ? '- n' � r r f 3" +r �*c
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IM.�, '�illc��l'�^, �.[� �C►'Iti►'�L' 5GFV s itiona wor to {eP-e' orme un er t is permit— c ec . a apply:
E1HVAC Gas Tank Gas Piping _ Shutters a Windows/Doors
01 0
❑Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 5 . Ft. of First Floor:
Cost of Construction: $ Ss to. UtilitiesSewer Septic Building Height:
Oil k+RILF+� r r r f:��g r
Name
Ir Name: Lary Licastri
Address: <3oo SNP/ �d �� I Company: Amengas
City: >'d r��g State: �Z Address: 3301 Oleander Ave
/ City: Fort Pierce State: FL
Zip Code: S� Z Fax:
Phone No. 7 ?`Z Ybt 7i Zip Code: 34982 Fax: 772-465-8448
Phone NO. 772-633-0740
E-Mail:
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: 02707/28579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. .
i
sE
KAM.
MORTGAGE COMPANY:
Not Applicable
DESIGNER ENGINEER: , Not.Applicabie
Name:
Name:
Address:
I
Address:
City:
State: 1
City:
State:
Zip: Phone:
I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
[Not Applicable
Name:
Name:
I
Address:
Address:
Itity:
City:
Zip: Phone:
Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as ma icateo.
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 pen
which is in conflict with any applicable Horne Owners Associate
structure. Please consult with your Home Owners Association a
In consideration of the granting of this requested permit, I do h
in accordance with the approved plans, the Florida Building Coc
The following building permit applications are exempt from unc
accessory structures, swimming pools, fences, walls, signs, screi
WARNING TO OWNER: Your failure to Record a Notice
lm ments to your property. A Notice of Commei
fore t fir "pectlon. If you intend to obtain fin
will authorize the permit, holder to build the subject structure
rules, bylaws or and covenants that may restrict or prohibit such
review your deed for any restrictions which may apply.
!by agree that I will, in all respects, perform the work
and St. Lucie County Amendments.
going full concurrencyreview: room additions,
rooms and accessory uses to, another non-residential use
Commencement may result in your paying twice for
Iment must be recorded and posted on the jobsite
*yg, c i1sult{-Rk1ender'or an attorney before
Signatur of Agent/ Lessee
a ur�onbractor/Llcense Holder
O RIDA
STATEIDA
COUNTY OF 5�- c�
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this ty day of 3 Q_' , 20 tiS by
this tt^l day of 3,rsZ . 20� by
e
(Name of person acknowledgin )
(Name of erson acknowledging
(signature of No u tc- State o lorida)
(Signature of Notary Public- State of Flori a )
ersonally Known_ O
Personally Known ,
Type of identification Prod Nora Pi , i,,
pe of Identification Produc o Notary Public State of Florida
rek AMAngela M Boore
Commission No.C^Ci1 O ` (+ mission GG 19Go"09
% 02/27/2022
w� M Commission GG 190809
OmmI551on Now-.,, cQ 00 POSIJ 02/27/2022
pp
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