HomeMy WebLinkAboutappALL APPLICABLE INFO MUST
Date:
FOR APPLICATION TO BE ACCMWD `
Permit Number:
Building Permit Application
Planning and Development Services SC n9 p 9
Building and Code Regulation Division eco Y fe'r
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
_x_:
PERMIT APPLICATION FOR: Fuel
Address:
Legal Description:
PropertyTax ID #: � l SUi - CC)C--)q "-C)(�)C7 r3
Site Plan Name: —
Project Name: ht 11' Pyt r' w
Setbacks Front._ Back: Right Side: �_ Left Side:
Lot No. `1�
Block No.
� CO�ISTRl1CTlOIV INFORMATION _ _
itiona wor to e e orme un er t is permit - c ec a apply:
OHVAC —,)Gas Tank Gas Piping Shutters F]Windows/Doors
I
Electric Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Z O o
Name t' y111<< CU Q.Wdq
Address: L b �(�� I �'Yl l 011N A V 2�
City: C-11� k C2 (ZQ_ State:
Zip Code: 4US Fax:
Phone N Cp -yl
E-Mail:
Sq.
of First Floor: _
Utilities: L_1Sewer OSeptic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
CONTRACTOR:: - -
Name: Lary Licastd
Company: Amerigas
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
Phone No. 772-633-0740
E-Mail: Brian.Pead@ame6gas.com
State or County License: 02707/28579
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Addlik
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
IZip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not 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.
11
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
"Ii1tlARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
EMENTS TO YOUR PROPERTY. A N F COMMENCEMENT MUST BE RECORDED AND
STB SITE BEFORE THE FIRST INSPE ION. IF D TO OBTAIN FINANCING, CONSULT
41THEM
OR AN ATTORNEY BEFORE RECOR G YOU OTICE F COMMENCEMENT:'
!g ature o wner/ Lessee/Contractor as Agent for Owner
Sig ature n or/License Holder
ST E OF LORIDA
STA FLORIDA
COU OF _ S\-
COUNTY OF fA7 LxZ!Q1e
he forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this o day of SUC1Q 20n by
this- day —I%- 20g by
�c—��•/ �C�t-�`
_of
) —
�/ V �TC1
Name of person aking statement.
Name of person n6king statement.
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
ype of Identification ��
Type of Identification
Produced Ah Notary Public State of F!c: ::
Produced 14Notary Pub%c State of Florida
Ange am Boore
My Commission 6G 19Gc-
,, nrg ..;�-� Ore
y c My i -�rnission GG 190809
Expires 02/27/2022
f or a Expires 02/27/2022
�al
:.
. .
.111, 1 I'll J , , , , - -
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
Commission No.Q_-.4-=i! { t (Seal)
i
Commission No.Q_�nqq:Cq (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19