HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONl
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !:� n!J�_r— Permit Number:
. i J-^ RECEIVED
• MAR 2 9 2019
• � aae
Bu ild i n%eArgbt-ApplicatiemSt. Lucie County
Department
Planning and Development Services BY y
Building and Code Regulation Division St. Lucie Coup},,
2300 Virginia Avenue, Fort Pierce FL 34982 `y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION
Address: 3(&08 Grove. Lori- _ Fgr+ Piute. Y FL 3N951
Property Tax ID #: J 37-7 - 305 - 0008 - 000 - Lot No. ) Z
Site Plan Name: Block No.
Project Name: &Shop G"S SvSienl
:..: � _. a •F
°'CONSTRUCTION INFORMATION: :.
Additional work to be performed under this permit -check all that apply:
_Mechanical Z(Gas Tank XGas Piping _Shutters
—Electric _Plumbing —Sprinklers —Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 5991.10 Utilities: —Sewer _Septic
—Windows/Doors
Roof Pitch
Building Height:
=OWNER%LESSEE¢__-
CONTRACTOR: r
Name fircnUS 6SShV
Name: LarryLicastri
Address: 3t} ;tla. �Ihn14,
Company:AmeriGas
City: For} Qiard- State: Ft-
Zip Code: 3`+'45 I Fax:
Phone No. 347 -359 - 1259
Address:3301 Oleander Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
PhoneNo772-633-0740
E-Mail: pe.cod21ceI1SouA-Ae}
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailAmeriGas-7262@amerigas.com
State or County Licensees/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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;;
« �}
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
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 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
WARNIN OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro ments operty. AN otice of Commence m be recorded and posted on the jobsite
befor first' : s echo If you intend to obtain financi consul er or an attorney before
ccm cin r reco If
our Notice of Commenc nt.
Signat a of O�ressee/Contractor as Agent for Owner
Si ature of ontractor/License Holder
STATE O
COUNTY OF
STA LORIDA
COUNTY OF 1V—
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
Y,
this% day of iY�c�t�c�(l 20a by
thiQ. day of tY1cL 1 20 N by
LcaSK� H l_��c,,Fj�cc�
v ( xcz 1a�
Name of person making statement
Name of person m king statement
Personally Known OR P=!ai
Personally Known %� ' 'Type
ofldentificationType
VTMM� of Flodda
ofldentification 5 aw NoWryPublfcstateorFiodda
'; a° -Angela MEooreProduced
Produced
5 VMy ommission. 190609
or
�. Expires 02272022
or
(Signs e o Notary Public- State of Florida )
(Signature of Notary Public- State of Florida )
Commission NaC_-=a lQ0 hCq (Seal)
Commission Nod 0C;, I9Q)CZ1ZI (Seal)
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Rev.8/2/17