HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED. FOR APPLICATION TO BE ACCEfnD OIL 51�
Date: kQ J V,41 JA Permit fumber:
' MI
Building'Permit Applicationplanning and Development Services Building and CodeRegulation Division
2300VirginiaAvenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Fuel q-S P % 0,
11 Address:
Legal Description:
Property Tax ID #: I IS --10 1 - 0Iz,4 - 000 Lot No. 1 1
Block No. J—
Site Plan Name:
Project Name: (XS' s
Setbacks Front 10 Back: 10 Right Side: )0 Left Sider_
Ie�ih1Q eXiS}In0 SAD W��1, /j@Mi Jco QL.,S��(o'II k
+0 exes.�ny simb,
1 Gas Tank
Plumbing
Total Sq. Ft of Construction: r1
rnct of rnnctn,rtinn: � z390 • (oZ
Piping
srs L-JGenerator
S�Ftt.1 of First Floor:_
Utilities: L JSewerfl5eptic
Windows/Doors �I
Roof
Building Height:
z
COIVfiRACT(?R
iilbea'} /2c, ou2Sy
La Lipsin
Name: RY
Company: Amerigas
Name
? Sb /Ilarina Ur'V2
Address:
Olprt2 State: J=1-
Address:33010;eanderAve
Fort Pierce FL
City: State:
City:G-'
—s
Zip Code: �✓''1 Fax:
S (0 I - 3% S - 5399
Zip Code: 34982 Fax: 77246543448
Phone No.
Phone No. 772-M-0740
Mail:
Fill in fee simple Title Holder on next page if different
Brian.Pead amen as.com
E-Mail: @
State or County license: 02707/28579
from the Owner listed above)
-L I'......nanroTPllY
IC ,nntilP,1
If value of construction Is sz5au or more,
SUPPLEMENTAL CONSTRUCTION LIEN®LAW INFORMATION
{a, ..i x +a x�:2 ,r. S�xY x.q. y ...<-:. xk
"xr •t.- 9c-m
_
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONI5ING COMPANY:
Name:
_Not Applicable
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.
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
WARN WNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr ements roperty. A Notice of Commencem be recorded and posted on the jobsite
befor a first in ctio If you intend to obtain financi g, consul rider or an attorney before
comm cin r o cording your Notice of Commenc ent.
Signatur of Owne Lessee/Contractor as Agent for Owner
Sign ture of ontractor/License Holder
STATE O A
STAT LORIDA
��
COUYQ NTY OF S l��
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
this l\ day of tav�bq�- , 20S$ by
this ll day of cr�S . 20 by
cr,f l C_� yC-
Name of per on making statement
Name of pers n making statement
Personally Known i P o c d ti is t'o
Personally Known OR Produced Identification
Type of Identification pf+k Notary Puhlie Sipte of Florida
Type of Identification
Produ agela-M Booie
Produced .h Notary Public State or Florida
GG 100600
+� Expires
�jp ' Expires 0727/207?
Angela M B ore
2G 180600
. 17 xptrea
a B0�7�
(Signature of Notary Public- State of Florida)
(Signature of Notary Public -State of Florida )
Commission No.(=-Q5\G01Z_ I (Seal)
Commission Nr�--G XgZkC I (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17