HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �O
Date: i[;;HNNW ::::) Permit N umber:
Rfc%Lv
• St. LudeCOB* JUL 10 2019
Building Permit Application hers It`n9 DeoartmenE
Planning and Development Services ucte County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential _
PERMIT APPLICATION FOR: Fuel III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: 1
Setbacks Front
E3HVAC
ftll ��Z
Back: � K3 Right Side: �_ Left Side: YL—
Gas Tank
Piping
ElElectric 0 Plumbing USprinklers
Lot No. 6 ** 'i
Block No. I
Shutters ❑ Windows/Doors
Generator O Roof
Total Sq. Ft of Construction: �� SqI FFtt.I of First Floor.
Cost of Construction: $ r� i� Utilities: L� Sewer Septic
Building Height:
DOWNER/LESSEE ryn,.
Name Cri!? 2.nP1C YYI l Q
CONTRACTOR - fs`
Name: Larry Licastri
Address: A q q5 Ibee1 n nix 'I 'o
Company: Ametas
Address: 3301 oleander Ave
City: Fprra T if-CU State:
Zip Code: Ug,LI(Q Fax:
Phone No.-1—1 a qj o l R(05'+
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No. 772-633-0740
E-Mail: Bdan.Pead@amedgas.com
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: 02707/28679
If value of construction is S25uo or more, a xrwnucu nonce ul a..,......... ...... ...... I ...—
SUPPLEM,ENTALCONSTRUCFIQLAW INFCtRMATI'IlON,.:;
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 TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impfovemeNs to your property. A Notice of Commencement must be recorded and posted on the jobsite
be a Ir t I pection. If you intend to obtain financi , co Gtnin rth lender or an attorney before
co a ork r recording vour Notice of Comme ment. � �
Sign ture of wner/ Lessee/Contractor as Agent for Owner
ignature of Contractor/License Holder
STATE LORIDA
ST OF FLORIDA
COUNTY OF SV
COUNTY OF \- L_xpc aJZ'
The forggoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this G day of So� 20-!9 by -
this't day ofI-A IF 20_ft by
t— lv-c'.4 p&y-'�
CI CV-4
Name of pers n making statement
Name of pers n making statement
Personally Known , OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identificati
Produ
Produced O%rk Nota lic 6Yate of Floritla
Diary Pumic State o! Florida
Angel gpq g40r
+o Angelq,M Boore
My Commission GG tsosos
MY Commission GG 190609
E
Expires 02/27/2022
aw Wes 02/27/202',
(Signature of Notary Public- State ofTlorida )
(Signature of Nota -
Commission NoC,-3q: -� Rgt (Seal)
Commission N��t�O(r,C'�{ (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17