HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number:
- SCANNED
Building Permit Application By
Planning and Development Services St. Lucie Countv
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential
PERMIT APPLICATION FOR: Fuel
(,PROPOSED IMPROVEMENT-LOCAT,10 ;=
Address:.76 6^
Legal Description:
Property Tax ID #: 3 y 03- r07- -o gSZ, —000 -4' Lot No.ZS_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORKJII
R UO A/C j � a$ I *W ��o.« exs�� i46o✓� fo�,oC 2 Soc9� ll`�*^ fu>L k
-1- AM w & ,'-ka ei ook uf 2 - F,Fye,:C o -i e 6ve.a C 040,
CONSTRUCTION INFORMATION:;
r
Add
rtrona wor to e errormea under tispermit—c ec a appy:
❑HVAC Gas Tank JoGas Piping _ Shutters ❑ Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 4-4 00,
S Ft. of First Floor: _
Utilities:llSewer ❑Septic
Building Height:
OWNER/,LESSEE
:. _ =
CONTRACTOR:
Name
Name: Larry Licastri
Address: 34q IF-
Company: Amedgas
City:14Q h6 woD-c/ State:%G
Zip Code: 3 30 Z-e Fax:
Phone No. 7 % Z, 613 J522
Address: 33010leanderAve
City: Fort 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.Pearl@amedgas.com
State or County License: 02707128579
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name•
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: ,Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 Countvimakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conflflct 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 Commencement may result in your paying twice for
im ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
fore tltg fir�i ection. If you intend to obtain finan ' , c rysuit vI I\1ender or an attorney before
STATE OF FE
COUNTYOF
3_�' L we
The f.o{{going instrument was acknowledged before me
thismdayof iYMO.`-6) .20_n by
STATE OFFLORIDA ll
COUNTYOF �T L,ude
The forgoing instrurgi�ent wa acknowledged before me
this � �0 day of t Y t 0.YCV 200 by
L aar� U CMAyi I l .A mA L. i Ccvsir',
(Name otpersim cknowledgin ) (Name of perso cknowledging
(Signature of Notary Public -State o rida )
Personally Known A OR Produced Identification
Type of Identification Produ ; ,� ^ none -
Commission No. rp� eCdpp K) MMISSN r FFi
• XPIRES Febfumy 01.
ZONING
REVIEWS I FRONT COUNTER . I REVIEWI SUPERVISOR REVIEW
4,&OVZ�
(Signature of Notary Public- State of F16cidd )
Personally Known Y OR Prndiir Identification
`rY MNISSION 8 FFi
S FNrwry 01.
PLANS
REVIEW I VREVI WON I S EV EWLE I MR VIEW