HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEFTED
Date: 11 I q SCANNED Permit Number: Ij
BY RECEIVED
• Sf. Lude loonnh/ AUG Building Permit Application zo
Permitting Department
Planning and Development Services 5t. Lucie 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: Fuel1.
III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: -
Setbacks Front �Q) Back: L�) Right Side: Left Side: 10
Lot No. L
Block No.
Y � �al1�n -1pnlL uno r6Ltri ' as vt n.e iu -tw,\ ess
WQIr'-I ru' 5 a�°Y , ayl�l h S�ub� QUn inleri0r
l;ir2A-0 ,LooACAIZIp Qr&
11HVAC � Gas Tank
llElectric 0 Plumbing
P - il El Shutters ❑ Windows/Doors
nkiers 1:1 Generator E]Roof
Total Sq. Ft of"Construction: S Ft. of First Floor:
Cost of Construction: $ ��J • �� Utilities:[]Sewer []Septic Building Height:
OWNER/LESSEE
GONTRAC70R'
Name
Name: Larry Licastri
Address: oZt/U2 N� r�7 v C/;
Company: Amedgas
City: %—� ����« State:,L
Address: 3301 Qeander Ave
City: Fort Pierce State: FL
Zip Code: 32! 9 t Z Fax:
Phone No. %J - yd S-/
Zip Code: �982 Fax: 772 465 8448
Phone No. 772-633-0740
E-Mail: Brian.Peari@amedgas.com
E-Mail: s - Cum,
Fill in fee simple Title Holder on next page (if different
State or County license- 02707128579
from the owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S,UPPLEME"T CONStRI qlC
N LtEN.CAV1/ INFORMATION
?'
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
W ING Your failure to Record a Notice of Co ncem t esult in your paying twice for
im roveme s to your operty. A Notice of Commence st be ecorde and posted on the jobsite
b e the spectio . If you intend to obtain financi , cons It lende or an attorney before
c In wo re r I our Notice of Commence
11
Si ature of 0 ner ssee/Contractor as Agent for Owner
Ignature of Co tractor/License Holder
TA OF ORIDA
ST E OF F ORIDA
COUN OF S\L_�1�
COU F
The forgoing instrument wa acknowledged before me
The forgoing instrument was acknowledged before me
thiszA�__ day of CA%z, 20IS by
thisZ day of 20_n by
`
Name of person making statement
Name of p rso making statement
Personally Known � OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prod Notary Public State of Florida
tProduced Var Notary Public State of Florida
AngelaiVl80ore
My Commission GG 190609
ngeJ9MBoore
p My Commission GG 190609
Expires 0212712022
or Expires 021272023
pprP
(Signature of Notary Public -State of Florida)
(Signature of Notary Public- State of Florida )
Commission NOGf�.P) (Seal)
Commission NrCotgO (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17