HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE ('' . ° ;PLETED FOR APPLICATION TO BE ACCErD '
Date: Permitliumber: )2ECEIVOED
y. DEC 2 6 Z018
Building Permit Application Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division S A
2300 Virginia Avenue, Fort Pierce FL 34982 Residential�< NFD
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Si Y g
PERMIT APPLICATION FOR: Fuel��
Address:; zl
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Z
Legal Description:
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Property TaxlDff:
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Lot No. (oZ
Block No.
Site Plan Name:
Project Name: Me,
14rdell GaS
Setbacks Front
1O Back: 10 Right Side: 10,
Left Side:
iO
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HVAC Gas Tank
Electric Plumbing
®Gas
r-• ••••. -•'-- - - 11 • •
Piping —Shutters Windows/Doors
11
11Generator Roof
❑Sprinklers
Total Sq. Ft of Construction:
rnetnfrnnctrilrtinn:S 2'h30 S2
S . Ft. of First Floor:
:1 _
UtilitiesSewer USeptic
Building Height:
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Address.-3 '31v
City: �rJ- Q,erLe State: FL
Zip Code: 3498Z Fax:
Phone No. BbzS
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name. Larry Licastri
Company: Ame as '
Address: 3301 CleanderAve
City: Fort Pierce State: FL
Zip Code: 34982. Fax: 772465.8448
Phone No. 772-633-0740
E-Mail: Bdan.Pearl@amerigas.com
State or County license: 02707/28579
_s e•_—...nnromant
is mn.Or.A
If value of construction is Szsuu or more, a nL .wn. .•�-•-- -•
S,tJPPLEMENTAL4CONSTRUGTIOiV
LIEN IAW INFORMATION'
. - " ',a.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING 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 CountyY makes no representation that is granting a permit will authorize the permit holder td 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
WMrovemenR
Your failure to Record a Notice of Commencement may result in your paying twice for
imroperty. A Notice of Commenc st be recorded and posted on the jobsite
on. If you intend to obtain fina cin cons t w' nder or an attorney before
cordingour Notice of Comme me t.
Signa re of Ow a essee/Contractor as Agent for Owner
ature of n or/License Holder
STATE RIDA
S TE OF LORIDA
COUNTY OF �� ll�
COU OF S� lid
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thial day of 20!.'&, by
thisZk day of 20I_q by
Lr_ v
statement
Name of person making statement
Peroduced Identification
Personally Known OR Produ'nTy
FiAUcs Florida
Type of Identification ; Notary Public state of Florida
PrNotary of
11gra
° M Bbore
My Commission GG 190609
• yomm12712GG\90608
' Expires 02YG7/2022
Expires 02127/2022 �\
a
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission Ncl(* oIRQ� (Seal)
Commission Noc-61kca (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