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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A V r ") Date: -7/ I6 SCANNED Permit Number: BY SLP012016 s St. LUCIe County PERN]ITTING � r- St. Lucie County, FL Building Permit Application Planning and Development Services /14ct J, ?7C✓r4 . /- Building and Code Regulation Division 7— ()ZZO 2300 Virginia Avenue, Fort Pierce FL 34982 u Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Fuel III Address: Legal Description: Property Tax ID #: Site Plan Name: _ Project Name: Setbacks Front Back: Right Side: Left Side: Lot No. Block No. DETAILED DESCRIPT(ON:OF WORK �►s // Z � (O©o L/ 'nil .ccbo.e5� pw�re ' f. �u /. ne *o b Lt/d-aj qrGs s- tb. /evw-,6y cv Ge -f. CONSTRUCTION.INFORMATION-(_ ❑HVAC Gas Tank ®Gas Piping ❑ Shutters ❑ Windows/Doors ❑ Electric El Plumbing ❑Sprinklers ❑ Generator ❑ Roof Total Sq. Ft of Construction: Cost of Construction: $ lI S00- i S Ft. of First Floor: _ Utilities:n Sewer 05eptic Building Height: OWNER/LESSEE CONTRACTOR: , Name Name: LarryLicastri Address: (% G( Cnw,o ,q6o�f Sa City: `TG, /�c kvr, w, a State: Zip Code: ?Z30 ( Fax: Phone No. 24 O 7 2 gC% f 31 E Z Company: Amerigas Address: 3301 Oleander Ave City; Fart Pierce State. FL Zip Code: 34982 Fax: 772465-8448 Phone No. 772-633-0740 E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail:.Bdan.Pead@amedgas.com State or County License: 02707/28579 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 09/01/2016 12:49 7724658448 AMERIGAS FORTPIERCE PAGE 01 .i.. Iry,��ij/j�,�,. yr•I ..�. ibD l.S`•I�� . .�`.' ; ,�. `� �:� .. :;ittli'::;yi,•:,;,:k�i-fi:;:.'��a::aiiyl,y��•�),r;`4.i�!f y;:: •1 �i..: i:: ..1 .: �:AY •1` 'P:'i'v .;i'i .� i�^...{ ��n,'_% . DESIGNER/ENGINEER, _Not Applicable MORTGAGE COMPANY: —NotApplicable Name: Name: Address: Address: city: State: _ City: State: Zip: Phone- Zip: Phone: FEE SIMPLE TITLE HOLDER: _ 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 [ounN make$$ no reprefent�tton that is grant�ng a �e{mit vtlll autrri:e th ermic holder to build the subject slhucture which is in co lct wltn anti appl Icab a Home Owners Isoc at on rules, by aws or a covenants that may restrict r ro iblt such structure. Please consult with your Home Owners Assoc ation and review your deed r any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I wlh 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, aaessorystructures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement maV result In your paying twice for im ments to your pproperty. A Notice of Commencement must be recorded and pasted on the jobsite fir If to obtain finan suit lender or an attorney before ore t ection. you intend men n k in our Notice of Comme ent ractor/Ucense Holder S ur of Agent/ Lessee *STATEFLORIIIA STATE 0 RIDA COUNTY OF S+. Luc( C. COUNTY OF S+. The forgoing Instrument was acknowledged before me The fo going instrument was acknowledged before me � this _JL day oolf�S®RyA�% b}e�� by this day of C� kJX . 20� by /y r220A I )r I Ir/r/, L, /�//N F- - Anihe, L. Dra (Plarne of person acknowledging)me (Naof person naacknowledging �2 y z 6Vw pL. (Signature of Notary Pubiio• State of Florida) (Signature of Notary Public- State of Florida) Personally Known OR Produced Identification Personally Known _ X_OR Produced Identification __A.._ Type of Identification Produced IdentiRcalIon Produced Commisslon No. COMMISSION OF 00% ion No. 1 �}p)CostaotteloN ■ F EXPIRBS Knnwry 01. . EXPIRES Pabn&W e .2020 ,., REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED -Re—v-7772014 u: