HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
ALL APPLI BLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED M
r,Date: Permit Number: 9 .
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Building Permit Application
Planning and Development Services 4� .
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
Address: ' S'3S l -AlaV ,' o.t't `j7 r --
Legal Description: �iF'P a._ P A4r
PropertyT_axID#: l'i 2qSo(— 0y16-- 0001'7 Lot NO.
Site Plan Name: Block No.
Project Name:
Setbacks Front —to Back: r_ Right Side: 0 Left Side: l �
p�ET�►IL==��tD�SC��PTI�N�O,FtrtAlO�Krk � ,��� �5� � � ' � ' � . { ' � ' �� �:�+ �; ?�� ;�.,� �� a ; ;���v
y �
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OS;RUCTION ItFOIIUTA�ff!
itiona .wor to M[Gas
eeorme un er trspermit—c ec a app y:
❑HVAC Tank 015a-s Piping. _ Shutters ❑ Windows/Doors
❑ Electric Q Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ l �Or "= Utilities: 0 Sewer 05eptic Building Height:
OWNEf��LESSfE � x r �_> 4h CONTRACTOR 3 � < ..r.n.� � wtipr
Name 7S&-mL, S241 .514I"G'^ Name: Lary Licastri
Address:_ ! 5 7-5—/ Nat,,. De- r Company: Amerigas
City:%a�a State: SC Address: 3301 Oleander Ave
Zip Code: rf g Rs Z Fax: City: Fort Pierce State: FL
Phone No. i 2 Z 612 SW Zip Code: 34982 Fax: 772465-8448
E-Mail:
Phone No. 772-633-0740
Fill in fee simple Title Holder on next page (if different E-Mail: Bdan.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.
DESIGNE
Name:_
Address:
City:
Zip:
NGINEER:
State:
Phone
ca
FEE SIMPLE TITLE HOLDER: <!� Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Applicable
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
impneS to our property. A Notice of Commencemnconsstlt
ber corded and posted on the jobsite
befst i p tion. If you intend to obtain financin ith der or an attorney before
cnmor r cordine vour Notice of Commence
Signatur of Ow e / Lessee/Contractor. as Agent for Owner
Signat a of ntractor/License Holder
STATE O RIDA
STATE O LORIDA \
COUNTY OF g� :x`C" \Q
COUNTY OF S\-
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this'i day of 20j& by
this day of �vtN+2 .20!� by
LC -Jr �/ a, ��(1
LGl�C1�/ �►c c�iC� G1
Nam of person making statement
Name dY person making statement
Personally Known X_ OR Produced Identification
Personally Known 2— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Publi a ""a="�'
Y
i nature of NotaryPubli' SteFlq�
(�.g sH�r)Public State of Florida
o Notary Public State of = :rids
;' �° Angela M Boore
Commission N 1 A e M Boore
M mission GG 19G609
gg
Rn My Q g�g��;Sion GG 19060i;
�mmC isssio `No. ' w� Expii $ 07J27/2022
CFI Expires 02/27/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 "