HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLL i _i�'� FOR APPLICATION TO BE ACCEPTED
Date: eL12 T19
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: k 63— 09-3
RECEIVED
MAR 12 2018
Building Permit Applicati011Irmittingoepartment
St. Lucie County
Commercial Residential X
PERMIT TYPE:
SCANNED
`Ri�t3PIjSEt) IMPit'G UEMENTfLt3GAT�'ON
�Pt R RrHRR
A R��� � �,
Address:_ NOS Golly L4n2 . Ford P.tr e- 1-I- 3494S
Property Tax ID#: Z305-5-00-OOi6-000-Z Lot No. Li'
Site Plan Name: Block No. lJ
Project Name: Qi ek 6A.S 516it'n
f3Uq SOO Q,.,lo„ +rMIC' 61d Nil G6s I;re do 9&w4A. me _54,ib . iAntltSs
Wa�+r hec.?f�y f'I,nO� rand (56fl sNb.
CONSTRUCTION ItUFORMAffON e' r# s 1t
Additional work to be performed under this permit- check all that apply:
_Mechanical A Gas Tank X Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (a7-5 • gS Utilities: —Sewer _Septic Building Height:
r
DOWNER/LESSEE , q ?fl r " 'r.' . F" �
., a
a,.!
iCONTRACTDR ..1� `. a+ t 1 ,
Name
Name: Larry Licastrii
Address:_ L}oo Svr1r15t pr;v2
Company:AmeriGas
City: J;r4- (2)arc- State: FI,
Zip Code: 2"IS Fax:
Phone No.
Address:3301 Oleander Avenue
City: Fort Pierce State:FL
Zip Code: 34982 Fax: 772-465-8448
Phone N0772-633-0740
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailAmeriGas-7262@amerigas.com
State or County License /28579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SU,PPLEMME
t7ALCONSTRUCl10lLIEN LAW INFORMATION
g ,
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
WAR O R: Your failure to Record a Notice of Commencement may result in your paying twice for
impr vement o you roperty. A Notice of Commence ent m orded and posted on the jobsite
befo first ect) . If you intend to obtain financ g, consu with I der or an attorney before
com cin rec rding vour Notice of Comme ent.
Si re of Own r essee/Contractor as Agent for Owner
Signature of o tractor/License Holder
STATE LO IDA
S TE OF LORIDA
COUNTY O �� 1 ap
CO OF
The forgoing instrument was acknowledged before me
this S day 01
The forgoing instrument as acknowledged before me
day
of V-C�5,A� : 20 by
this oKC , 20J�3 by
Name of person milking statement
Name of per making statement
Known.<OR Produced Identification
,pnPersonally
Personally Known
Type of Identification
'• ubrieSlatootFloriCa
Type of Identification yYrf�otary public State of Fiorio:.
fN
Produce
prod d M Boore
aojennpla
�MB
mission GG190606
My Commission GG 19G60S
or Explres 02f27/2022
02/27/2022
(Signature o otary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No w "lOfd",yj (Seal)
Commission Norc ACAQCJ)q (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 8/2/17