HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q �G SGAINNM Permit N oFb7.N'St LudeComty P ]1 2019
Building Permit ApplicatiPlanning and Development Services ng Department
Building and Code Regulation Division ie County, FL
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: Fuel III
Legal Description:
Property Tax ID #: �Q ` 4 t I — WQC)— 000 — I Lot No.�_
Site Plan Name:
Project Name:
Front Back: 111.) Right Side: `�—_) Left Side: I Q)
Setbacks
Block No.
S3--) C-1-t-cinY-� PJur1 any o -ext gas C,0_Q and Ss' i6
�as L�nsz - VC oYNNFss w Q�R_Y lr?_C x l '��Ve and r3 �
iditional work to be Pertormea
E1HVACL.-�rGas
unaer cros
aas
perms—cnecK du
Piping
dVPiy:
Shutters
Q
Windows/Doors
Tank
_
0Electric
OPlumbing
Sprinklers
nGenerator
Roof
Total Sq. Ft of'Constructioon: q� Sq. Ft. of First Floor.
Cost of Construction: $ 5 JLQ • l�� Utilities: Sewer Septic Building Height:
Name 16YQn In(II'P-.1/
Name: LarryLicastri
Address: 5 OfGM& Nc )t
Company: Amedgas
City: V'tY«-z State:
Zip Code: 3Hq L1"� Fax:
Phone No.
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
Zip Code: 34982 Fax: 772465-8448
Phone No. 1-I& ' l`bB�D
E-Mail:
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
State or County License: 02707/28579
If value of construction is $2500 or more, a RECORDED Notice of Lommencemenc is regmrea.
'.n
1ElV L4W'INFORM/{Ti01
SUPPLENiCNTALCOrN5TRU ION72
upsr „ _ f s `3;;
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
Wgove
O : Your failure to Record a Notice of Co result in your paying twice for
ime to your erty. A Notice of Commenc mu a recor dand posted on the jobsite
f1 n ction. you intend to obtain finan g, co su I�Ir lend or an attorney before
or recor ine vour Notice of Cnmme c ant
i
i
Sig re of 0 see/Contractor as Agent for Owner
ure Icense Holder
STATE IDA
�
CTATEOFF ORIDA
COUNTY OF ��— i--K 1�
NTY �a
The forgoing instrument was acknowledged before me
. The forgoing instrument was acknowledged before me
thisl0 day of.201!� by
this 10 day of�1� T— 20g by
M1C'_F_, Nf Cc._6� Cl
cA M v C-- C�c t1
�l
Name of pe5son making statement
Name of p rson making statement
Personally Known :�<—OR Produced Identification
Personally Known 1: OR Produced Identification
Type of Identification
Type of Identification
Produced gootio4b. Notary public State of Florida
�IProduced aT"I' NotWublic State of Florida Q
'
Angela M B )ore
�r MyGommisiion GG 190809
,;dt Angela M Boore @@@
W Commission GG 190609
Expires OX27/
Expires 0227202;
(Signature of Notary Public -State of Florida)
a (Signature o Notary Public- State of Florida )wor
Commission No.0 (Seal)
Commission NoQ�%-C`Q (Seal)
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Rev. 8/2/17