HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIr � ~
ALLI APPLICABLE INFO MUST BE COMPLETED. FOR APPLICATION TO BE ACCEDED
D te: Ck Permit II umber:
RECEIVED
Building Building Permit Application SEP 10 2018
ing and Development Services
ng and Code Regulation Division ST. Lucie County, Permitting
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
4IT APPLICATION FOR: Fuel SCANINIP
"H �t Yt5 .a5sy.t ,_+ N•��; t `'ti °'� ,Lr .x. ..r. •. is rh .ut_._,. 3.r.,•�
Z Se'M o 16 Dr,
Description:
Prop" Tax ID #: 3'{�� , gOZ - 000} _ 000 _ � Lot No.�_
Site 31an Name: Block No.
Project Name:
Setlil cks Front Back: Right Side: O Left Side: 1 D
Qvr� Soo be'no►1 ry-"FAye ,j4AV A'Id fvij gas 11Me d-0 9e,,erc.i-or.
Additional oak to ba unaer maPim'CLn tl1 �aFFly-
1HVAC Gas Tank �pgShutters
DElectric L7 Plumbing OSprinklers 0Generatol
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost f Construction: $ Z395- u3 - __ Utilities:0Sewer U-Septic
❑. Windows/Doors
❑ Roof
Building Height: II
01N1.5afE
�,
t NTH y F,w h -
. a AcraR
NLarry
Naml
Address:
City:
t>HV,'d W6. 14Y-S
Name: Licastri
Company: Amengas
Address: 3301 Oleander Ave
907- D,r%V2
�- ',�C, � _ State: �L
or ,c'
Zip
Phon
E-Ma
ode: , S4987- Fax:
No. �Z - 7.0) ' R$
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No. 772-633-0740
il:
�Ifee imple Title Holder on next page ( if different
Fill in
E-Mail: Brian.Pearl@ame0gas.com
from
he r listed above)
;wne
State or County license: 02707/28579
If valde of construction is $2500 or more, a KtCUKuru mouce or wlruncul6cu.auL lO ieyun eu.
I
PPLMENTAL
GCiNSTRLIGTION LIEN LA�W�NFC}R(vIATICii.
�, ��
a
o
,.. ..... ,. �o. .... n
x x
DgSIGNER/ENGINEER:
—Not Applicable
MORTGAGE COMPANY: _ Not Applicable
N
rn
Name:
A
Address:
dress:
Ci y:
State:
City: State:
Zi
Phone
Zip: Phone:
FE�
SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Ad
A ress: Address:
Cite
• City:
Ziplf
Phone: Zip: Phone:
OW
ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cer JifV
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
in Home Owners Association bylaws that restrict
whictj
strulure.
is conflict with any applicable rules, or and covenants may or prohibit such
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 adordance
with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f
I (lowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acce
sory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA
NING TO OWNER: Your failure to Record a Notice of Commencement may. result in your paying twice for
e o r property. A Notice of Commenceme mus a rded and posted on the jobsite
tefore
th first inspeon. If you intend to obtain financin consult ith le der or an attorney before
enc' 'o k or 1�l�ee in our Notice of Commen a nt.
i atu essee/Contractor as Agent for Owner
Signature actor/License Holder
OF F ORIDA
ST�JN
FLORIDA
COT F
COUNTY OF l�ca�
The forgoing instrument was acknowledged before me
The forgoing instrume t was acknowledged before me
this IG day of 20_ti by
this Clo.. day of 20�% by
L= '� V
,
Name of perJon making statement
Name of p rson making statement
Personally Known K OR Produced Identification
Personally Known OR Produced Identification
Typ�" of Identification ryr
- Type of Identification
Produced ft& Notary Public State of FInr;Q�7
3E�ngela
Produced 1t Notary Public State of�lorida
M Boore
Commission GG '90,605
ff�.
Angela M Boore
My Commission GG 80808
Expires02/27/2022
ires02/27
(Sig otary Public -State of Florida)
(Signature o ublic- State of Florida )
i
Commission No �.� tcNfrCJ (Seal)
Commission Now (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
f
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
REC1
IVED
DAT
COMPLETED
Rev. 8, 2/17