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PPLICABLE INFO MUST BE COMPLETED. FOR APPLICATION TO BE ACCEPTED
Permit g umber:
RECEIVED
Bu.lid'ing Permit Applicaiio OCT 16 2018
ing and Development Services 5T. Lucle County, Permltting
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
ie: (772) 462-1553 Fax: (772) 462-1578
IT APPLICATION FOR: Fuel
Commercial Residential
FL_ 7j''I9
R
yTaxlD#:
n Name: 1n12,n I-1 F w�� I- P n►� 1
Name: oc �hS
Front Back: �_ Right Side: Left Side: 1
Lot No. ZS
Block No.
y
Sep M-0 �hlloh 'Above. g"Ijld
l
In �.� er 0,r u- sav b oar A,,c'WIN-
r�'c�9✓e
VAC Gas Tank
ectric 0 Plumbing
Total SI Ft of'Construction:!
Cost of construction: ') 3
Piping
Sprinklers
apply:
Shutters
Generator
S . Ft. of First Floor: _
Utilities: Sewer OSeptic
11 Windows/Doors
Roof
c
Building Height:
QWI/LE�5EE
: t Name.: Larry Limtn
Name 1►dw�� „� . `1r�ar,l�, .
Address: �) 4
� ��� Company: Amerigas
I � �-% Q► �� State: � Address:
City:
3301 Oleander Ave
Zip Code: �`e�� Fax:
City: Fort Pierce State: FL
Phone No. �2 - Z) Zip Code: 34982 Fax: 772-465-8448
E-Mail: �1n1of i�, �bZ (2mtir) , LPhone No. 772-(i33-0740
Fill in fee simple Title Holder on next page ( if different E-Mail: Bdan.Pearl@amedgas.com
from the"Owner listed above)
State or County license: 02707/28679
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip'; Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
W Nt�tttNN66��TO OWNER: Your failure to Record a Notice of C �rrttene a ult in your paying twice for
i provemerl o ur property. A Notice of Commenc en must recorde id posted on the jobsite
b ,,the fi ' t in tion. If you intend to obtain finan consult ith lender r an attorney before
co me your Notice of Commen a ent.
OF
ee/Contractor as Agent for Owner
s1r Uxi-Q-1
I
The forgoing instrument was acknowledged before me
this l!5 day of<Zszkc-IN� 20�5 by
Name of person making statement
Personally Known OR Produced Identification
Tvpelof Identification
Notary Public State of Florida
Angela M Boore
My Commission GG 190609
Expires 02/27/2022
of Notary Public- State of Florida )
NoC`.CtcjC)cjsz�q (Seal)
REVIEWS
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
1
FRONT I ZONING
COUNTER REVIEW
of Cffifraicense Holder
TE OF F RIMnLaf �DA uY-3L-1;�11
The forgoing instrument was acknowledged before me
this IS day of 201� by
Name of pe son making statement
Personally Known_ OR Produced Identification
Type of Identification
Produced
c o ary Public St$te of Florida
? Angela M Boore
My -Commission GCS 190609
�04y; Expires 02/27/2022
(Signature of Notary
Commission No.Qk510k011kC-q (Seal)
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW