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ALL APPLICABLE INFO MUST BE COMPLETED. FOR APPLICATION TO BE ACCEPTED
Date: f• Permit N umber.
I
RE
CEIVED
Building Permit Application
Planning and Development Services
1 Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial — Residential
,JUN .2 6 1019
=ermitting Department
Gt. Lucie County
1' PERMIT APPLICATION FOR: Fuel I
Address: / llD I
Legal Description:
Property Tax ID #:
Site Plan Name: Q jVtn iA- ,
j Project Name:
Setbacks Front_ Back: l D Right Side: %. Left Side: / ID
Lot No.
Block No.
'�U n Clew l I ne 4 an1, Ao 'ne_u
Additional wor to e e orme un. er t is permit— c ec . a app y:
E1HVAC Dias Tank Kkas Piping _ Shutters ElWindows/Doors
Electric 0 Plumbing OSprinklers 1:1 Generator 011oof
'Total Sq. Ft of"Construction: hh
Cost of Construction: $ V
S . Ft. of First Floor: _
Utilities:OSewer Septic
Building Height:
OWNER/LES5EE.
_
►1
Name: Larryticastri
Name
Company: Amerigas .
Addrr ss: 2Lo'11 har Qu
Ci 'f i. � �L�r 4 State: if `
ty: �, (
Address: 3301 Oleander Ave
Zip Code: Fax:
City: Fort Pierce State: FL
11C,:. 2�1__ (V9DQ
Zip Code: 34982 Fax: 172-465-8448
Phone No
E-Mail:
Phone No. 772-633-0740
Fill in fee simple Title Holder on next page ( if different
E-Mail: Brian.Pearl@amedgas.com
from the Owner listed above)
State or County License: 02707128579
IIif value of construction is $2500 or more, a RMOKOW wonce or wmmencc111U11L 10 Iegwrea. II
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:
Name:
Address:
City:
Zip: Phone:
Not 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 ma result in your paying twice for
im en our property. A Notice of Commencem m recor d and posted on the jobsite
b fore th t insp �tion. If you intend to obtain financin ,cons It with lend r or an attorney before
co mend rk or ecordine your Notice of Commence ent.
re of(Owner Lessee/Contractor as Agent for Owner I Signature of Coftractor/License Holder
STATE OF FLORIDA STATEDf-FLORIDA
COU OF COUNTY OF SN- lam\ e
The for oing instrument was acknowledged before me,
his tday of �L . 20 I�1 by
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced ter•.
Notary Public State of Florida
Angela.M -Boore
a My Commission GG 190609
• r,P Expires 02/27/2022
(Signature of Nota
Commission No.GGICNCZ (Seal)
REVIEWS I FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
thi L day of �`Y1Q 2011 by
Name of herson making statement
Personally Known >< OR Produced I J n 'f' i n
Type of Identification 1,'�
Produced °f Notary Public State of Florida
(
Commissionsion G 190609
Ex
+or a°aA Expires 021271202222
(Signature of Notary Public- State of Florida )
Commission No.C-_-,)Calc-IOEi'R (Seal)
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
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