HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST q�" DO
UST BE COMPLETED FOR APPLICATION TO BE ACCEFrED f
Date: T,I?2,tIq Permit Number: I -I
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Building Permit Application se" FO
Planning and Development Services s '��ng 6'1oq19
Building and Code Regulation Division 40czeNa
2300 Virginia Avenue, Fort Pierce FL 34982 CIO ep�
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial- Residential
I PERMIT APPLICATION FOR: Fuel III
Address:
Legal Description:
Property Tax ID #: i y- - Lot No_L
Site Plan Name: G,fa2L r1C L Block No.
Project Name:
Setbacks Front I l7 Back: M) Right Side: �_ Left Side:
Gip (SCANX2�1C1
he n�X AYLr� vc�or g l� -ho �QY11CuLss 1n1l�ler he�{er
HVAC v v 0Gas Tank
Ereas
Piping
❑_ Shutters
Windows/Doors
Electric 0 Plumbing
Sprinklers
1:1 Generator O
Roof
i
Total Sq. Ft of'Constructi`on:
Cost of Construction: $ `Q%�3
S . Ft. of First Floor. _
Utilities:Sewer Septic
Building Height:
Namem!P FS T\" "any- , a�
Name: Larry Licastri
Address: t-\1\ 10 C>T\ -3r L
Company- Amen as
City:State:
Zip Code: 3��� Fax:
Address: 3301 Qeander Ave
City: Fort Pierce State: FL .
Phone No.
Zip Code: 34982 Fax: 772465.8448
Phone No. -112- (A\DS-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: 02707/28579
If value of construction is szsuu or more, a KmuKutu Wouce or wnnncua.cu.c..a m 1c4mwu.
5UPP1 EIVECNTAI'CONSTRUCTiQN11ENt�4WffiINFQRMA7tE5lU a } f
`r !>", �"A
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 represehtation 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, Ido 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
W6RN1NQ TO OWNER: Your failure to Record a Notice of Com ement may result in your paying twice for
i provem ur property. A Notice of Commence nt mus ded and posted on the jobsite
b ore the spe ion. If you intend to obtain fjnanci consul ith len r or an attorney before
: e n k or r cording your Notice of Commen a nt. /
Sign ure of ssee/Contractor as Agent for Owner
nature o icense Holder
STATE OF FLORIDA
S LORIDA_
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
. The forgoing instrument wasacknowledged before me
this_ dayof�20VA by
this �day oi� .201n by
�cr y L��c>��cc�N
( XQu%\r6
Name of persn making statement
Name of perscin making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
_
Type of Identification
Type of Identification
Produced o'er"° Notary Public State of Floridaf(Soignateucire
rduc
v M ela M Boore
Y Commifton GG f eoem
oj0.� •ty_ Notary Public State of Florida
r Angela M Boore
°•pdF Expires .02127/2022'
+d My commission GG 100609
i =i �! EXP10e4212712022
(Signature of Notary Public- State of Florida i
of Notary
Commission NoGQ.-�kcAlb J9 (Seal)
Commission NoQE 9.0 — q (Seal)
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Rev.8/2/17