HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONrQ
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3�1Gi\\� Per
1
MAR
Building Permit Applic tion Department
permitting
Planning and Development Services � COUntyr FL
Lucie
Building and Code Regulation Division St.
1300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
ANNIE
PERMIT APPLICATION FOR Fuel BY
..,
11 T10N,
PRQf?05EQIMPROUEIVIE141 •"'
Address:�i \ EVy�2.Y��\/ ✓i I eX (� r �1 3 GIB
Legal Description: t } � v--k y g 67s S '< 3 C%I
l v-r 3 ( --k- N L) 7, 04- 1, LIA-
r% y— �7 Oyy— 2 Lot No. 3 to r ( y
Property Tax ID #: f7 4( t� 1/
Block No.
Site Plan Name:
Name:
Project
Setbacks Front Back: Right side: Left Side:
fn,r DEW ORK
A,LEODESCRIPTION
VA ,co ,
01 Ll f 4-t- 1, Ly\,
L -�--A D W Y' 1 \ Fes^ �' YL �1 G CJC C ln� Gl D J✓ SAL'i"o
e,�'s � �1 �-, �< j ti s� ,awl•-f 1,=� �.
,
Addrtiona wo. to jepe orme un ert rspermr -c ec a appy:
❑ Windows/Doors
CJHVAC LJ Gas Tank Gas Piping _Shutters
11Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: c� SqI FFtt.� of First Floor:
ElSeptic Height:
Construction: $ 1 11 0y Utilities: Ll Sewer Building
Cost of
Name: Larry Licastri
Namee►J►3
Company: Amedgas
Address: �i I 1 EVVF2�VGr
Address:3301 Oleander Ave
City: Fort Pierce State: FL
city: --Stater
<�— Fax:
Zip Codi�3t"(,�
PhoneNo.'o'O'�'—d—� Lo ~aS�!s
Zip Code:34982 Fax:772465-8448
NA"ry 0 � Vyl� ' 1
Phone No, 772-633-0740
E-Mail: Bdan.Pead@amedgas.com
E-Mail:�ke \Au,✓ rM[
Fill in fee simple Title Holder on next page (if differeW
from the Owner listed above)
State or County license: 02707128579
ction is $2500 or more, a RECORDED Notice of Commencement is required.
Ln!
,-F Tg
....4
Fa:
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: ^ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TME HOLDER: _ 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
no
the permit holder to build the subject structure
r ano covenants that may restrict or prohibit such
:ed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I adll, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie CountyAmendments.
The following building permit applications are exempt from undergoing a full connrrrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impuAigments to your property. A Notice of Commencement must be recorded and posted on the jobsite
foil re tft first insnection. if you intend to obtain finani:Wffl,-coRsult rvitk (ender or an attorney before
STATE OF'T O �A 3� STATE OF FLC1R1 3
COUNTY OF COUNTY OF $ g
_ o
The lia ing instrument was acknowledged b The f r oing instrumentwas acknowledged befo b? m
this ] 'L day of rYM)'i1!>i� 20� � = this day of
kicas+6
(Signature T
otary Public- State of Florida)
Personally Known OR Produced Identification
Type of identification Produced
Commission No. (Seal)
acknowledging
/J�Vwp—�
(Signature o taryPublic- State of
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
REVIEWS I COUNTER I REVIEW S REVIEW R I REVIEW I y REVIEW N. I SEREVIEW E I MREVI EWVE