HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _11/r$ SCANNED Permit Number:
BY
St. Lucie County
RECEIVED
Building Permit Applicatio
JAN 17 2018
Planning and Development Services
Building and Code Regulation Division
ST. Lucie Couflt P0PR11fEIRg
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Fuel
IMPROVEMENT
LOCATION
';PROP(QSED
Address: 5306 Sd-ee
Legal Description:
PropertyTax iD #: 10,50-- 3/! - = 6 — 00 0 - f Lot No.
Site Plan Name: Block No.
Project Name: 7 elid D
Setbacks_ Front Back: Right Side: Left Side:
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'DETAILED DESCRIPTION OF,WORIC '
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CONSTRUCTION,INFORIVIATION,
Additionalwor to e e orme un ert ispermn-c ec a apply:
�HVAC be2GasPiping _Shutters ❑Windows/Doors
Electric 1:1 Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First'Floor:
Cost of Construction: $ rdD.- Utilities. Sewer Septic Building Height:
=`OV1lNER/LESSEE _
CONTRACTOR :e
d
Name /u A. 9 5a F6..-%fir L G G
Name: Lary Licastri
Address: 22 a . f£j jai
Company: Amen gas
City: C�e State:
Address: 3301 Oleander Ave
City: Fort Pierce State: FL
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Zip Code: *7 Fax:
Phone No. 27 2yS P 7 fl'X4
Zip Code: 34982 Fax: 772-465 8448
E-Mail:
Phone No. 772-633-0740
Fill in fee simple Title Holder on next page (if different
E-Mail: Bnan.Pead@amerigas.com
State or County License: 02707128579
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: ,NotApplicable
MORTGAGE COMPANY. Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
BONDING COMPANY: uNot 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 CountyAmendments.
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
impromia,ments to your property. A: Notice of Commencement must be recorded and posted on the jobsite
fore t fir ection. If you intend to obtain finan ' , c suit I lender or an attorney before
men n k Your Notice of Commen nt
-recDrdling
Signatur Agent/ Lessee
a ure nuactor/License�Holder
O A 1
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TOSTATE
RIDA '�+COUNTYOF COUNTY -OF
The forgoing instrument was acknowledged before me
this I-) dayof 20Xby
The forgoing instrument was acknowledged before me
this11dayof F&7 20—Cby
CL'((U L;k C.fa+'i
rM I CO Skn
(Name of person ackn ledgiinn )
(Name of person ac(nowwled�gingT
(Signature of Notary Public- State ol"Florlda )
(Signature of Notary Public -State 6fflorlda)
Personally Known X_ OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification Produced
'"1�•.•,_ AMBER L D
Commission NO. Tr Q :{J ) COMMISSION M FF
' EXPIRES Fatvuery 01
T of Identification Produ
� ;p'K"' , AMBER L DIAZ
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ission No.�r954{ :.: .•: M(c@AyISS$0N # FFM14
2020 •••. ,a ,• EXPIRES February 01, 2020
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.