HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CON' 1:rED FOR APPLICATION TO BE ACCEPTED /� �T n --so
Date: J a )Ci . SCANNED Permit Numbe :
BY
�i St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Fuel
Address:
Legal Description: Uy k JA U2 0 O
av — '-,e r-fi,
MAY 13 2019
Permitting Dep ment
St. Lucie nty, FL
ME
PropertyTax lD M,: LA I -)'A - S(u�i , O Dl to , C>O D — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front __ -A J Back: 1 0 Right Side: 11% LeftSide:. I L
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INFORMATION
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rtlona wor to
e e orme Under t permit- cneCK all
112al apply.
E1HVAC
_ Gas Tank ❑Gas Piping
_ Shutters
❑ Windows/Doors
11 Electric
0 Plumbing Sprinklers
1:1Generator
E:] Roof
Total Sq. Ft of Construction:
S
Ft. of First Floor:
Cost of Construction: $ a> 0 L) • 1 Utilities:Sewer
Septic
Building Height:
Name
Name: Larry Licastri
'
�\Y Address: ) n$,�DD t% \.V-\
Company: Amerigas
City: I'DV-T V\,Cy State: \
Zip Code: 3 Ci Ll S- 2 - Fax:
Phone No. `l1 I- — S Sz� — �1Ci (-A l- P
Address: 330101eanderAve
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No.772-633-0740
E-Mail: VAC,V� ' LL1\L C 01,A(Cr -
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-Mail: Bdan.Pead@amerigas.com
State or County License: 02707/28579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Ask
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:_
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Applicable
_Not
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 authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association bylaws
rules, 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
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
OWF_FOTR IMPROVEMENTS TO YOUR PROPERTY. A NO F COMMENCEMENT MUST BE RECORDED AND
OSTE N T :,JOB SITE BEFORE THE FIRST INSPEC N. IF ND TO OBTAIN FINANCING, CONSULT
TH LEND OR AN ATTORNEY BEFORE RECOR G U OTICE F COMMENCEMENT."
Signa re of 0 /net/ Lessee/Contractor as Agent for Owner4ure
ractor/License Holder
STATE O LORIDRQA
STATE OF FLORIDA
COUNTYOF 51— lax
COUNTY OF SL ls::'c%JQ_'_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this l0 day of McaT_ 201a by
this %0 day of MCA— 20_n by
I C_t,cr L1 r ,
l�c,�cr y l�cras� ci
Name of person ma mg statement.
y
Name of person making statement.
Personally Known 4-_ OR Produced Identificatio
Personally Known P c I 'fi a ion
Type of Identification
Produced gv Nola:z Public State of Florida
Type of Identification
rOd Uced a' N°taly Public State of Floridatgela
M Boore
A Boore
3 My Commiss:cOCG 190809
Expires 02&12022
`� g My CommissitmQG 190809
'1qa Expires 02/27/2027
t 10rwo$
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
Commission NBC-, (Seal)
Commission NoCd-,lcic_l C (Seal)
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