HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEFrED
Date: 7/17 f 1 9 Permit N umber: t �1y 1_ o` �
OuAlmimui
BY
St LUC a County RECEIVED
Building Permit Application Jill 19 2019
Planning and Development Services P&MItting department
Building and Code Regulation Division St. Luere County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Fuel
Address:
Legal Description:
Property Tax ID #: C) Co — ooC7 -"�r Lot No.00,DI
Site Plan Name: Block No. a a
Project Name:
Setbacks Front l L' Back: 10 Right Side: \ Left Side:
, r'" S � q 'as 3 s r' �. .i 3 s .? ♦ y _ T Sf iA WN3 j ,. i
DETa% DESCRIPTI0IVC)FV1�0(k
� �, d M ,+y .1e n; r e tit ,�,.: 3v� ^' .. wf- G .♦ r-.'ssg .,� x �+ 5. �:.
1-1) new
❑HV-. V v Gas Tank
Bas
Piping❑_Shutters
[]Windows/Doors
❑ Electric 0 Plumbing
❑Sprinklers
❑ Generator ❑
Roof
Total Sq. Ft ol"Construction:: ��
Cost of Construction: $ 01Qf J.
S�Ftj. of First Floor. _
Utilities: Ft
[]Septic
Building Height:
Name
ey4parizi
Name. Lany Licastri
Address:
Company: Amergas
City: • t f C0 State:
Zip Code: ?—HS 1 Fax:
Phone No. "l1 00 3 3a kA1 a \
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772A65-8448
Phone No. 772-633-0740
E-Mail: Brian.Pead@amedgas.com
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County 0cense: 2B579
If value of construction Is $2500 or more, a RECORDED Notice at commencement is requnea.
I
SUPPLEMENTAL d TRUCT10NIJEN
LAW INFORMATION:
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:
_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.
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
WARNING TO OWNER: Your failure to Record a Notice of Commence result in your paying twice for
5formrlencin
ven �'ns
property. A Notice of Commenceme mbe reco ed and posted on the jobsite
ethe 'ion.If you intend to obtain financin consu t len er or an attorney before
ecordin our Notice of Commence t.
ure of O essee/Contractor as Agent for Owner
Ig ature o ctor/License Holder
STATE RIDA
STA F ORIDA
COUNTY OF `a�r l
COUNTYOF Sk Lac \Q
The forgoing instrument was acknowledged before me
The forgoing.instrument was acknowledged before me
thisl�d day of Sv\� 20� by
this 1� day of T.�k 20a by
Name of plekog making statement
Name of person making statement
Personally Known ^ OR Produced Identification
Personally Known >—OR Produced Identification
Type of Identification
Produced
Type of Identification
Produced it No a Public State or Florida
c State or Florida
' Ange a.M 800re
Angela M 9ogre
MyFummimian GG 190609
y, • My Gommissiori 2 190609
@p 4?,.s O 712 2
s t�ras 0212712022
(Signature of Notary i - t t 0f [or! a)
(Signature of Notary Public- State of Florida )
Commission NoQ� \qOf ( (Seal)
Commission No( % 9 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17