HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CON%°'IED FOR APPLICATION TO BE ACCEPTED ' ,1�`j l a • O `/
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Date: lad ) Q Permit OUT ) o
RECEIVED
Building Permit Applicafc n DEC 2.0 2018
Planning and Deveiopmentservices Permitting Department
Building and code Regulation Division St. Lucie $enty, FL
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Fuel
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f
Legal Description:
Property Tax ID If, 1 11 50Z - OD 1) - 000 - J Lot No. i
Site Plan Name: Block No.
Project Name: �0'rr!ne'VI
Setbacks Front 10 Back:Right Side: LeftSHe:�
C.1d el W4-r IHJo✓v1 7.00it- fr oPk4- krmY A J Y11n
/1')L,.ru {Z.G}vPeti �om� dr-0-174-192 Wnn&�-f-raoh .
Gas Tank Gas Piping
❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
rust of Construction: $ 9?)0 % )
Shutters ❑Windows/Doors
Generator 11 Roof
S . Ft. of First Floor;_
Utilities:l lSewerUSeptic
Building Height:
y
77
O` �V] R/ SEE :.' <x x
Name rr a
8or'
Addressc-& 10 �I^bl�n�-I G� r� le
city:(or+- Vlert1L State: FL•
_
Zip Code: Fax:
Phone No.. ,SOS ' 7ii%b.- q'��
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above) .
CONTRgCTC+R
Name: Larry Licasd
Company: Amergas
Address: 3301 CleanderAve
City: Fort Pierce State: FL
Zip Code: 34982 Fax. 772 46543448
Phone No. 772-633-0740
E-Mail: Brian.Pead@ame6gas.com
State or County 4cense: 02707/28579
_at-.. ..L
rn...rnenramPet IS mnuirad-
If value of construction is 5zsuu ar more, a no.. n -•
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION ,, ,k,
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
BONDING COMPANY: _Not
Name`:
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
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
im � (property. A Notice of Commencem %stt
ecorded and posted a thebefore
b fore the r Insp ction. If you intend to obtain finan ' g, cwit lender or an attorney beforec encin rk or ecordinR your Notice of Commen en
lure of 0 er/ Lessee/Contractor as Agent for Owner
nature o Con ractor/License Holder
STAT ORIDA
S O FLORIDA
COUNTY OF 75 - c ..t
COUNTY OF S1- LsY_I P
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
this day of 20Sg by
this 1%_ day off o��r 20by ,
)
Name of person making statement
Name of person Aaking statement
Personally Known P c I t I 'o
Personally Known r e f' i
Type of Identification r or Florida
la Notary Public
Type of Identification Notary or Florida
Produced rp
gelrhmi
Produced M.BState
M•Boore
My Cor?tmission GG 100609
sio
- Expires 022�72022
My Commission GG 190609
�or Expires 02/27/2022
( or
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission NO��<<l0�'1 (Seal)
Commission NoC-:olO1Q)(g79 (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