HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLLIc�.i. FOR APPLICATION TO BE ACCEPTED _
Date: �I �$ Permit g umber:
I
RECEIVED
Building'Permit Applicatio
N0V O 1 2p18
Planning and Development Services ST. Lucie CodfltyF roe fife@ii1Q
Building and Code Regulation Division -
2300Virginia Avenue, Fort Pierce FL34982 Residential_
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _
PERMIT APPLICATION FOR Fuel
SCANNE®
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Address:
Legal Description:
Property Ti x ID #: �� _ Z33 V Od�3 ~ 000 _ 3 Lot No.
Block No.
Site Plan Name:
Project Name: Dc )aS U; S m
Setbacks I Front i O Back: I O Right Side: Left Side:
Grp: Soo 9�1l0n ink c,•►d Y'Qn 94s /;ne. +-o
itiona wrtoPormeuneon_
❑HV IC ICI Gas Tank Gas Piping _Shutters a Windows/Doors
j� I
U Electric 0 Plumbing Sprinklers Generator _ Roof
Total Sq. Ft of Construction: S . Ft. of of First Floor:
Z3�S Utilities: LJSewer �5eptic Building Height:
Cost of Construction: $ .
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{
REP
�0�41 hS
Name.,..1, ��h�t�a ' An1�h�o�.� r
Address: 3'+q b 1r9h) ►2.w�..� D��,i ��
N E i yti
Name; Larry Licastri
Amen as
Company3301
Qiet-L9 F L state:�lr
Address: 0eander Ave
City: Fort Pierce State: FL
34982. 772465-8448
City:y 1-
Zip,Code:i `3''i'9�•�' Fax:
32SL}
Zip Code: Fax:
Phone No.
772-633-0740
l
Phone No.
E-Mail: I
if dill. Brent
simple Title Holder on next page ( .
E-Mail: Brian.Pearl@amerigas.com
Fill in fee
State or County license: 02707/28579
from the Owner listed above)
I
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL�CCEiIVSTRUC�'ION LIEN LAW INFf3�R�MATIQN.�
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DESIGN�R/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: I Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name: I
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: Phone:
I
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
WAR TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
i rovemen perty. A Notice of Commencem a corded and posted on the jobsite
b fore the fir t inspecti . If you intend to obtain financ' g, con ult ith nder or an attorney before
rn enrin� uv k or rec rdinE vour Notice of Commen nt.
ureof0 ner essee/Contractor as Agent for Owner
gnature o Con ractor/License Holder
7STATF F RIDA 1 r
TE FLORIDA,N
CO OFTeorgoing
F\�
instrumeQQt was acknowledged before me
. The forgoing instrum nt was acknowledged before me
this day of 20ff by .
thiscpCo day o �_ , 201E by
Name of peillson making statement
Name of per on making statement
Personally Known 'X . OR Produced Identification
Personally Known O r e I e 'fi a ion
Type of Identification I
Produc .lam Notary Public State of Florida
Type of Identification
Produce gyp'% AN Notary Public State of Florida
la M Boore
Boore
My Commission GG 390608
Expires 02/27/2a22
— f
My Commission GG 190609
p p Expires 02/27/2022
(Signat otary Public -State of Florida)
(Signature of otarT u ic- State of Florida )
Commission Now-, (Seal)
Commission NaC-�-�1 CA-O(Seal)
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