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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPOD 9 o O Y Permit llember: Dater RECEXVEI • _Building_P_ermit_Applica(I _ FEB 252019 Planning and Development Services Permitting DepaftM Building and Code Regulation Division St. L COUnty, F 23o0Virginia Avenue, Fort Pierce FL34982 Re -di, Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial SC PERMIT APPLICATION FOR: Fuel }uq{', j♦�r`�� R3 ":' T. h t _: ^s }F:.r'- Z �^:'h F6 ���.. �, :.!y.i���iiA... { ` Address: 7 r t d f� P-0 t� `eft L 3L)9 S Legal Description: Voe t n (AKA Doirc,., SuWw"S:on, Black A Lo}S 1 Z 3 10 11 ti d IZ Owai,,l U ord '357-3 PAaf 1143 ' f: ; 1 `'la ©��� —���� LotNo.lz31!a Property TaxlD#:) ?�G� swl'`on )0 TownSl,ln 35 So�i H iLa o7 39 f� s} Block No. A Site Plan Name: 1 e cr ied Project Name: ` tiS S Setbacks Front_] O _ Back: )4 Right Side: 10 Left Side: ) 0 t7 L., Yy 1 [T 1� �.'�vj`�, [03 j-07-777 1'4 }�< i uT `'"• 6�r Soo gi,non 4%,nK (4,yha- Sde• C. mouse and r,ln 9,.3 );ne- 4-0 yf4eWor 1 sib,--4-Anrle5S yra+Cr 6"4-W, gas cook+0p, rAhd Ua s+vb. 0`(S8 ` .W�in Addrtiona wounder this permit- c ec a app y: ❑t Me Shutters dows /Doors❑HVAC Gas Tank IgGasPiping OElectric OSprinklers Generator 0Roof Plumbing Total Sq. Ft of Construction: S . Ft. of First Floor. OSeptic Height: Cast of Construction: $ 59'tb • fo0 UtilitiesSewer Building OWYEfa/tE§SEE „P i�o�S 7svm' t°w�3 YaAn Name LarryLicaslri Name P QioX 161,34 Company: Amerges Address: 0 Stater Address: 3301 Oleander Ave City: rot'} Q e+rLC Fort Pierce State: FL Zip Code: 3%19t 1 S Fax: City: Zip Code:34982, Fax:772465-MB Phone No. ��2 7.a1-q���i ------- ------ -- -. -- -- -- - 772-639 740 - - - ------ - - -- - PhoneNo.- - E-Mail: E-Mail: Brian.Pearl@amerigas.com Fill in fee simple Title Holder on next page ( if different State or County license: 02707/28579 from the'Owner listed above) If value of construction is $2500 ar mare, a RECORDED Notfce of commencement is required. it 4NED Y County A! ,x :� kr1t•T »g. sM.{viy r 1 ��rpQ\l (61£I 1A11 iNFQ ATtCPI l� rri` i �� itAu; w"eF'.iWt�i 8010 V �+'R+ t _ i . a `...s`'t 0✓.i ,dh tn. "✓ r: it T.R3 .i.'9 .. e• �0 I e .. .`. o-A� DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: Address: -City----- - - - Zip: Phone - - --State:- - --City---- --- Zip: Phone: --- - --State:-- — FEE SIMPLE TITLEHOLDER: _ 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 Count 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 WAR TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for Xe en to yo perty. A Notice of Commencementent sd\and posted on the jobsite oe first in pest . If you intend to obtain financin consu er or an attorney before In1 r rec rdine vour Notice of Commence at. Lessee/Contractor as Agent for Owner Signatur =FDA Signa a of C tractor/License Holder STATE STATE OF FLORIDA COUNTY OF SV Laa %R COUNTY OF S\- The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this t9 day of 6'4t)r3g c S` 120 n by this %cl day of � 20n by L—ca c-c�"v 1 . L.Xc-f✓y(-I Name of person making statement Name of person triaking statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced V%'h NotaryPu ic State of FleriCa ela M ore produced Notary Pugic State of Florida Angela M Moore My Commissio GG 19009 Eapires02/27120 2 < My Commissi GG 190609 Erpire502/27*t122 ar _ (Signature of Notary Public- State of Florida) (Signature of NotaryPublic- State of Florida ) Commission N6--�\y0 (Seal) Commission No.f3,=\c{pr (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW ATE-- - - --- - - - -- -- - -- -- - - -- RECEIVED DATE COMPLETED Rev. 8/2/17