HomeMy WebLinkAboutBUILDING PERMIT APPLICATION09/12/2018 11:39 7724658448 AMERIGAS FORTPIER_C_E PAGE 01
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO'BE ACCEPTED
Date: 7/ �f+nn,�� Permit Number: fibBY
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St Lucie COLO
Building permit Application
Planning, and' Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34W2
Phone. (772) 462-1553 Fax: (772) 462-IS78 Commercial Residential
PERMIT APPLICATION FOR: Fuel I
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Address: �DA
Legal Description:
Property Tax ID #: rr. ��� __�1' ' Q D L y C) D D g lot No... -
Site Plan Name: 3aln 1 -A a,,Lau,✓ _ Block No.
Project Name:
Setbacks Front Back. a Bight Side: I left Side: 1
0.
Additional work o b rme undertrils erm - c eCK
all
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UShutters
apply:
❑
❑HVAC
s Tank
Windows/Doors
❑Electric 0 Plumbing
Sprinklers
0
Generator
Roof
Total Sq. Ft of Constrution-
1
S . Ft. of First Floor:
0sewer USeptic
Building Height:
Cost of Construction: $ utilities:
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Address: "S 3 l k((,�
State"E-A
Zip Code-3 ( Gl Fax-
Phoiie No. 1 0 "r
E-M1ail;
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Larry Licastd
Company: Amster,
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No. 7724333.0740
E-Mail: Brian.PeadQameriges.com
State or County license: 02707126578
If value of constmetlon Is $2500 or more, a RECORDED Notice of Commencement is required.
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rSUPPtEME6VTAL CQN5TRU�TIQN LIEN lAW #NaR1VlATION a x;
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: of Applicable
Name:
Name:
Address:
Address:
City: State:
City: - State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of 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 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
improvements to your property. A Notice of Commence ust be recorded and posted on the jobsite
be _ Fe -the firs *nspection. If you intend to obtain financ n , consult l lender or an attorney before
co men n ork or recording our Notice of Commenc nt. 1
Signa ure of 0 ner/ Lessee/Contractor as Agent for Owner
SigWonse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S\-
COUNTY OF f� I�GQ
The forgoing, instrument was acknowledged before me
thisa0 day of ,%zP QI 20� by
The forgoing instrument was acknowledged before me
this day of wr@ , 20 � by
Name of person making statement
Personally Known � OR Produced Identification
Type of Identification
Name of persc making statement
Personally Known X_ OR Produced Identification
Type of Identification
Produced
Produced
(Si o ary Publi St q F o7l a
o NO Public State of Florida
r An ela Boore
JCommission No. I 1� My t3�i*sionGG190609
aor Expires 02127/2022
( Otary Pub a f Fit tttblic State of norida
Angela M Boore
My mnr��ssion GG 190609
Commission NO�`7 k Eup �9?U2712022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED.
>>Q
�L•(l_
DATE ' -
COMPLETED
Rev. 8/2/1T