HomeMy WebLinkAboutBuilding Permit Application i
i
i ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A I L1�116 Permit Number: W.I d'J ISS
s o ' RECEIVrD NOV 10 2016
Building Permit Application
Planning and DevelopmentServices
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: e2ol, �'j4S �-o &*s u4 e.r
PROPOSED IMPROVEMENT LOCATIONn
Address: /O 12. a:AMa C �T_/
Legal Description:
Property Tax ID#: I{ Z S- ?O/- 0 1 7 6- (Q U0-,Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks, Front Back: Right Side: Left Side:
DETAILED DESCRIPTION4OF
CONSTRUCTfON INFORMATION
_ _
Add
itiona work to e e orme under this permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _LJ Shutters Q Windows/Doors
Electric Plumbing Sprinklers El Generator ❑Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ "Z,SD� $ Utilities: _Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR = _
Name Or-y,3 A4Pi Name: Larry Licastri
Address: 2 Company: Amedgas
City: ( /tn State: L Address: 3301 Oleander Ave
Zip Code:,Zg.4 3 Fax: City: Fort Pierce State:FL
Phone No. -77 q4.5 Zip Code: 34982 Fax: 772465-8448
E-Mail: Phone No. 772-633-0740
Fill in fee simple Title Holder on next page(if different E-Mail: Brian.Pearl@amedgas.com
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.
M
� F etc, 4L-'
T
t P t t NNK-1ASMI
�._;`r'?.,..::,,w,,.�.
DESIGNER ENGINEER: Not.Applicable MORTGAGE COMPANY: ,_ Not Applicable
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 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 Commencement may result in your paying twice for
improvAments 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 "W—c sult r lender or an attorney before
men n k in our Notice of Commen mentIlk
Signatur of Agent/Lessee =STATEFLORIDA
ractor/License Holder
STATE.O RIDA' } Lai e,
COUNTY OF S'�. LV 1�1 COUNTY OF T
The forgoing instrument was acknowledged before me The ing instrym�eat was acknowledged before me
this_ 'r day of N0VeM .e1'r
\n .20% by this 1� day of NDYQXV by .20J�E by
RfAkr L U a2
(Name of person acknowledging) (Name of person acknowledging
2f
ue �z
(Signature of ffotary Public-State of F r'da) (Signature o Notary Public-State of rida)
Personally Known X R. ed Ider M L onally Known X dR. ed Iden
FF Type of Identification Produ ts
FM T e of Identification Produ Q _
g 45 MIMt&S19k 095s
PJ(PfttES February Ot,20 OC mmission No.FFg5(vlri EXPIi2RS Februery 01,2020
Commission No.F�15&lw •;eo;s� ea "o•u
r+ow swvea.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE IMANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.712014