HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED PermitNumber:
BY
St. Lucie Countv
Building Permit Application orTR
Planning and DevelopmentServices Pei .
buildingand Code Regulation Division t. 4,u
St a @per"'�
2300 Virginia Avenue, Fort Pierce FL 34982 � � !
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Fuel III
Address:
Legal Description:
Property Tax ID #:
Lot
Site Plan Name: Block No.
Project Name: c �7 1 ►l�� ZI.K�
Setbacks Front C) Back: , k Right Side: -%Z) Left Side: ,
seeIr
> ►ao 5���� lay aim -ran
HVAC L_�3 Gas Tank UGas Piping
Electric 0 Plumbing []Sprinklers
nm lob` QOis Jim -
Shut ters ❑ Windows/Doors
Generator - ❑ Roof
Total Sq. Ft of'Construction: S Ft. of First Floor.
Cost of Construction: $ a 09 D •�� Utilities:[]Sewer []Septic
Building Height:
CCitT OR k r .
Name)y7
Name: Larry Licastri
Address:1 013 Tole eyrie In
Company: Amergas
-
City: ` tYQR— Stater
Zip Code: 2340, -6 Fax:
Phone No.
Address: 3301 Cleander Ave
City; Fort -Pierce State: FL
Zip Code: 34982 Fax: 772-465-8448
PhoneNo.
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 Commencement is required.
35UPPLEM 7AL*CON 1 RUCTION L N W1N �11
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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
impr is t roperty. A Notice of Commence
bef re the Inspecti . If you intend to obtain finan
co encl rk or rec rdinR your Notice of Commer
as Agent
STATE OF FLORIDA
COUNTY OF S! Li�Cu
The forgoing instrument was acknowledged before me
this So day of CSZN-TtSYns?f . 20l`A by
Name o person making statement
Personally Known >� OR Produced Identification
Type of Identification
Commission
REVIEWS
Rev.
Notary publi State of Florida
Angelr{W%ore
My CoIrMUSIon GG 190809
Expires 02/27/2022
may result in your paying twice for
corded and posted on the jobsite
�Ielfder or an attorney before
Holder
STATEMIF FLORIDA
COUNTY OF �� lX_)
The forgoing instrument was acknowledged before me
thiskit, day of.201�1 by
U_X� �/ L_ACS� C\
Name of p rson making statement
Personally Known,_ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi S FlprAtlj�j)pvblic State of Florida
_ Angela M Boore
Commission N ft.(paMion GG 190809
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