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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I
Permit Number:
f - - R C,E 111i V �
Building Permit Application
Planning and Development Services PEM10ITTiNG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Fuel
PROPOSED IMPROVEMENT LOCATION
Address: /en `
Legal Description: �a��' t S
Property Tax ID#: ;?3Z 2— 700 Dcal t9oo—ZZ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK
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tar SOC7��.//D;•I - nil ®� � -f sic U �LDLJ'N. LCA /�� 8 4-0
ON"!",WI9_N
Additional work to WG!smank
e un er t is permit—c ec a app y:
C�HVAC ❑Gas Piping _Shutters ❑Windows/Doors
0 Electric 0 Plumbing Sprinklers El Generator Roof
Total Sq.Ft of Construction: ScFt.of First Floor:
Cost of Construction:$ iZQ(�� i Utilities. Ft
Septic Building Height:
OWNER/LESSEE - CONTRACTOR
Name `' .11'l_` Name: Lary Licastri
Address: Company: Amerigas
City: ?o ly- .0/' L-,k
State: L Address: 3301 Oleander Ave
Zip Code: 3�f�'j�S Fax: City: Fort Pierce State:FL
Phone No. S6/- 236— q 7 12 Zip Code: 34982 Fax: 772-465-8448
E-Mail: Phone No. 772-633-0740
Fill in fee simple Title Holder on next page(if different E-Mail: Brian.Pearl@ame6gas.com
from the Owner listed above) State or County License: 02707/28579
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
J ---—
09/01/2016 12:49 7724658448 AMERIGAS FORTPWE PAGE 01
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DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: Name:
Address:— , Address-
City.,—__ -- -- State: City: State:
ZIP: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable SONDIN43 COMPANY: ,•,•_Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application Is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie[aunty makes no repre ertt ftion that is grantans$ape{mlt VII authorize the permit holder to built the subject sttrya�tura
which is in conflict with an ppca s Home Owners oe at on ru es,by aws or a covenants that may,restrict r prohihft such
structure.Please consult w�th your Home Owners'Associationcrnd review your dead for any restrictions which may apply.
in conslderation of the granting of this requested permit I do hereby agree that I w111,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 applicatlons are exempt from undergoing a full concurrency review:room additions,
a=65orystructurm,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 rasuit in your paying twice for
im Iments to your roperty.A Notice of Commencement must be recorded and posted on the jobsite
ore t fir ect�on.If you intend to obtain flnan cult lender or an attorney before
men n k in our Notice of Comme ant
S ur=twderrftent/Lessee I ure o ntractor/License Holder
STATE A STATE FLORICA
COUNTY OF S -. L.Lw t COUNTY OF +,
The forgoing Instrument was acknowledged before me The fo going instrument was acknowledged before me
this--U day of St' W IRLe 2oA�A by this day of St V*&A f,r- .20-"L by
L. bICA2- I�er oraz
(Narn—e—ol person acknowledgin ) (Name of person acknowledging
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida
Personally Known.�)( _OR Produced identification Personally Known sit Produced identification
Type of Identification Produced Jwm r Identification Produced
Commission Na.Ep %1q57 AW CouttLit98IpN OF asaoi ssion No: 1yCAatMtSBrOrt N FFQ u
EXPIRES Crbrwry 0 ,2020 EXPIR138 ftWwry 01.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
t7ATE
RECEIVED
DATE
COMPLETEID
ev.