HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEF?ED ,,� I
Date: / / T SG`ANWr-n Permit Number: I an�' w5a
St. Luce Coup
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 - Fax: (772) 462-1578
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Commercial Residential
PERMIT APPLICATION FOR: Fuel III
Address:
Legal Description:
Property Tax ID #: 1301 ' UA — l 1 T'► L 0 ` DUD Lot No._21b_
Site Plan Name: Block No.
Project Name: A
Setbacks Front,11Z Back: VQ Right Side: Left Side: VD
DETAILED DESCRIPTID�V'(3FrWORKin
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IGas Tank
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Gas Piping
U Shutters ❑
Windows/Doors
Plumbing
Sprinklers
0 Generator
Roof
"total Sq. Ft of Construction: S� of First Floor.
1 �Qo 5
Cost of Construction: $ r�G'I l J O ' Utilities.. Sewer _Septic Building Height:
Name aY-n Lrno %k
Name Larry Licastri
Addres�s: 5CC
Company: Amedgas
Citv;t:urA tP�IEXI_y State:
Zip Code:, �q5 Fax:
Phone No.
Address.3301 OeanderAve
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-46541448
Phone No. 772-633-0740
E-Mail: Brian.Peari@amedgas.com
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County license: 02707128579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 comAwnceqient may result in your paying twice for
im ove lr o yo property. A Notice of Commence ant must rded and posted on the jobsite
b e the 'r t inspect n. If you intend to obtain financin cons t ith len er or an attorney before
cc enc' r or rehordiriRvour Notice of Commence t.
Signa ure of O n ssee/Contractor as Agent for Owner
e r/License Holder
STATE ORIDA
rSTA%TF F RID�
s�c-'Q
UNTY F
�GQCOUNTYOF\—
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this; day of �.�\20B by
this JSC day of3'�\y 20ka by
Name of berson making statement
Name of person rnlaking statement
Personally Known �� OR Produced -Identification
Personally Known PadAdmPHSi
Type of Identification ''d°='
Type of Identification �,�"° Notary Public State of Florida
Produced o no Notary Public State of Flonoa
la hi BOyre
'Produced Angelam Boore
Y'✓Onuwm Sion GG 190609
Expires 02t27/2022
My mmission GG 100609
�ja 02127/2022
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(Signature o ary Public -State of Florida)
(Signature of Notary Public- Florida )
Commission No.� Lci�y (Seal)
lState yof
Commission Nd EnGa!R -�I (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17