HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE C'_:_ !LETED FOR APPLICATION TO BE ACCEFrED
Permit II umber:
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5..... E EI D
Building Permit Applica0on JAN 2 2 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
23QO Virginia Avenue, Fort Pierce FL34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Fuel
SCANNED
Address: ids S ^t -6M 1
Legal Description: -3 34 40 N 1/ Z O F W /,%/ `i O F SV� )%4 O F A 1/ 4
of- SW 1 / 4 LESS W (*0 f'T (► 04 AL)
Property Tax ID#: Do IS — 000 — I Lot No.
Site Plan Name:
Block No.
Project Name: Trtke4a9x Q2sldentL 6#.S S:gsmKm
Setbacks Front_ Back: ) 0 Right Side: )0 Left Side: �0
1�urj Soo 9auon OAK cnd run 91,5 )ine to 9erwAtor S+vb, wiaw
hemcr (4*,hk- less) I ghs -c ooK+ap , J\- Na 54-ub .
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appy:
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E1HVAC
IX
Gas Tank
gGas Piping
Shutters
Windows/Doors
Roof
Electric
0
Plumbing
Sprinklers
Generator
Total Sq. Ft of Construction:
Cnst of Construction: 5 (o6�4 • fZ
S . Ft. of First Floor: _
utilities:Sewer Septic
Building Height:
FCt-�s r ,'
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401'CN,i�CTRMM
Named 12Xi S TC; Si¢ 't fQF2l n�
Address: I-IZZ Dusk W�.I
Name: Larry Licastri
Company: Amergas
` State: _EL
City: Fns� P v�
Zip Code: Fax:
"5`19tiS
Phone No. ��Z ZOt —9g33
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: 33010ean derAve
City: Fort Pierce State: FL
Zip Code: 34982- Fes. 772465 8448
Phone No. 772-633-0740
E-Mail: Brian.Pead@ame6gas.com
State or County license: 02707/28579
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IC Rn. ri�oll
If value of construction is S75130 or more, a nmwnuc- —
111=1
SUPPLEMEN_TALCONSTRUCPIONLIEN,-L�WINFO,;'�MATION•._.
_ �-
w �� `
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:
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
WAPIMA TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
im r�vj
r property. A Notice of Commencement must orded and posted on the jobsite
be t'ns a 'on. If you intend to obtain financin , cons i I der or an attorney before
com r r cordingour Notice of Commence nt.
Signatu of Ow er/ Lessee/Contractor as Agent for Owner
S=uretr ctor/License Holder
STATE OF FLORIDA
$RIDA
COUNTY OF 5�- 1 Sz_
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this t� day of--Sc i\,\::ir_/�f_, 20 n by
this lfoday of M—cAj1� 20 n by
L
�iL�c� L
G�L� �/ �1�LCr'S�• c1
.i s c S` w�� Gl
Name of peilson making statement
Name of person makillig statement
Personally Known R,AVe1cW lleetffletrli0lr+
Personally Known r e f i n
Type of Identification �,rsr NolaryPnblic5lateorFlorida s
Angela
Type ofldentiliication
Notary Pu6ik State or Florida
Produced Moore
mission GG 790608
Produced �e'+�ry'
agela M B�re
+�
Expires 02127120Z2 rY
Nly
� �'� Expires missionD2/2712GG 90609
p
(Signature o otary Public- State of Florida)
(Signs u of Notary Public- State of Florida )
Commission NO.S� l (Seal)
Commission Nod—_ —IL--� (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