HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�_ r
APPLICABLE INFO MUST BE COMr ei eD FOR APPLICATION TO BE ACCEPTED
Date: �'ec� �G%, Permit UUrn
—_ Building Permit.Applicatio FEe 2 20)9
Planning and Development services Permitting Department
Building and code Regulation Division St. LUCIe C Unty, FL
2300VirginiaAvenue, Fort Pierce FL34982 Resl en la
Commercial
Phone: (772) 462-1553 Fax: (772) 462-1578 _
PERMIT APPLICATION FOR: Fuel
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Address: J$�00 /ylrrl, Ong I�IV� Por+ S+ Lu�''e FL
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St. Lucie Cou 1
Legal Description: Ere,
Property Tax IDfl: 3ZIS- $01 - 0011 ' 000 -� No. ' ��
Blockot
Block No.
4Sr
� Site Plan Name: %,jS6,1 oley�Ge
Project Name: v5 5 ttivr
Setbacks Front )0 Back: 10 Right Side: 10 Left Side: 10
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AdUtional wor to e e orme under this permn C ec a Nip y:
❑Windows/Doors
0HVAC �GasTank ®Gas Piping
nn_Shutters
gElectric li❑Sprinklers Generator 13 Roof
Plumbing
Total Sq. of'Construction: 5 . Ft. of First Floor:
Ft
Cost of construction: $.�jq a� .) Utilities. Sewer Septic Building Height:
ss 4tu�al i<.
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Name: Larry Limbi
,- d Ds
Name ' 6„cb
Company: Amergas
Address: 18� I ik+J }%hurl (ovr+ _
Address: 3301 CleanderAve
State: L
Po ttur.ie �-
City: Fort Pierce State:FL
city: _ �'+ S� _
Zip Code: Fax:
NO
Z)/�`-
Zip Code: 34982. Fax: 772-465-8448
_Phone No. }Z
Phone No. -772-fi33-D740
E-Mail: Bnan.Pead@ame6gas.com
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County license: 02707128579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�UP�� ' IE., 1:AVJ tffitMA� ICNr ; .�
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DESIGNER/ENGINEER:.
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
-City— -- —
---State:--------
-City:------
State.
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
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 authofize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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
WARNIN TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr eme toyour property. A Notice of Commencement must be recorded and posted on the jobsite
be f a firs sp Ion. If you intend to obtain financin , co It It nder, or an attorney before
com err: o or r ordine vour Notice of Commenc ent.
ssee/Contractor as Agent for Owner
Signatu=OFRIDA
ture of ontractor/License Holder
STATE
STATE LORIDA
COUNTY OF S� wcae
COUNTY OF si- uxs-2
The forgoing instrument was acknowledged before me
thdayof20La by
The forgoing instrument was acknowledged before me
thisa�J_day l 20 C4 by
�4-MV L\CSI�S�C�
-of�j
1
I.CI.S-4-'/ LAcsyri
Name of pliirson making statement
Name of s n making statement
e
Personally Known
Known
Personally Know r I ' l
Produ Type f la
s° Notary Public Slate or Florida
An ela M Boor$
P� My Commission GG 190609
wpe� Expires OZ712022
Type of Identification .ra' Notary Public to of Florida
Produced S la M Boor
. My Commission G 190609
2'a Expires 02/27I2022
(Sign ary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission NoC'�'-pt90� (Seal)
Commission NoC—roR�(Seal)
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ZONING
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MANGROVE
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-DATE---
RECEIVED
DATE
COMPLETED
Rev. 8/2/17