HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((��
/ Permitgumber: I'
Date:
SCANNED
BY R�Fti
Building Permit Application %9 oe1p/9
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Fuel
PfsOPQSEq IMPRQVEnIIIVT I;OCATipN hf,� ter.
Address:
'f
Legal Description:
/ \ U - so\ p Lot No.
Property
�n 2_L �(Lrt f��hG Block No.
� �' ��
Site Plan Named ��
Project Name:
Setbacks Front_ Back: I 'V-)_ Right Side: �_ Left Side: _ -
F "s.x t sty Y 3
DETAILEEa^D�SCRIPTIONOFv ' r
a s
Ur c-�+wnK CA ,-t-r��p'►pew endµ
Bj-�b and Cz0Y-XP '
Additional wor to e PeFlullficu un UU1 t rspermlt—c ec a appy:
a'jGasPip- El QWindows/Doors
❑HVAC GasTank _Shutters
Q OSprinklers 0 Generator O Roof
Electric Plumbing
Total Sq. Ft of Construction: n (� S Ft. of First Floor:
� "I Septic Building Height:
Cost of Construction: $ i y Utilities:Sewer
r(1c�i 1 Name: Larry Licastri
Nam e�n\
LNtzkS Company: Amerigas
Address- SE�h (w
State: F L. Address: 3301 Oleander Ave
City: Qav\e _
Zip Code: Fax- City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No.
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail.
State or County license: 02707/28579
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,PP afJEt�ONs;T �ucr�o(�v.
FORMI
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER:
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,
accessorystructures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residential use
WA TO OWNER: Your failure to Record a Notice of Com ment may result in your paying twice for
i&ov,e me is to your property. A Notice of Commence nt mus a eco d and posted on the jobsite
b pection. If you intend to obtain financi suit d or an attorney before
e r r recording your Notice of Commenc ent.
Sig ture er/ Lessee/Contractor as Agent for Owner
Lure of Cot ense Holder
STATE LORIDA
ST OF F RIDA
COUNTYOF
COLIN lAxa2
The forgoing instrument was acknowledged before me
. The forgoing instrument was acknowledged before me
this C� day ofS2��c�r r. 20 ��lby
this Co day of 20-B by
L-� Y L:�.s� n
l-• v �e
Name of persoq making statement
Name of p1d9pon making statement
Personally Known l OR Produced Identification
Personally Known A OR Produced Identification
Type of Identificatio
Type of Identification
Produced
Pro lic state of Florida
�tolatypeblic stateof Flo`nd"
Angela M Boo te
Angela M Boore
- 190409
my iFyYP
+� MY Comtgission 6C 190409
Exp 0y27/2022
4404
w rs"f Expires,02/27/2022
re of Notary Public- State of Florida)
(Signature o NotaryPu ic- Stta�atee oon a
Commission NGigR (Seal)
Commission NoC���1dw—I (Seal) -
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Rev.8/2/17