HomeMy WebLinkAboutLight Pole and Bases PErmit Application Love's #467All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 LOZv Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34.982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
P
-313- Cn)-rte/
DETAILED DESCRIPTION OF WORK -
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
1 1,
Lot No.
Block No.
0 Z04 -
Additional work to be performed under this permit –check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
X Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ utilities: —Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name `-5 v G.
Name: 34A N16V4�;.�
Address: 10& 01 Al,
Company: L Cvt'S °
City: Oklo,Aom& 4;& State: GK
Address: 170 BV ,517.7
Zip Code: Fax:
City: 64&4PG0A6t state: TN
Phone No.
Zip Code: -7406 Fax:
E -Mail: CA�fiicr��n_ � .��%i�S_ PUM�tLiSG'� Ou�G3 �
Phone No 4
Fill in fee simple Title Holder on next page (if different
E -Mail n 0 c.&o. '.6vwi
from the Owner listed above)
vV
State or County License_ 5117,6
it vame or cons uunon is zzvu or more, a KLLUKULU nonce OT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
uwritml VDIV KAUVIR AFFIOVIT: 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 Count�r makes no representation that Is granting a ermit will authorize the permit holder to build the subject structure
which is in gonfllct with any applicable Home Owners Association rules, bylawsr 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev h4nrp rnmmpnrina wnrle nr rarnrrlino vni it tVn4lrn of
Love's Travel Stops
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IN 1 1 1 1 A n & Countx.,�, Stores, Inc
gnt re
af se
vner! Lese/Contractor as Agent for Owner
Si - ture of Contractor/License Holder
STATE OF FLORIDA OKLAHOMA
STATEOF.FLCI
COUNTYOF C)KLA H0MA _ _
VIATeRne=ee
COUNTY OF WM t Ito Y)
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
this _12_ day of Aio„ st 2020 by
LLgstal Vickers
� Physical Presenc or Online Notarization
this _, day of _, 2020 by
A�®�r 0—
Name of person making statement.
Name of person making statement.
Personally Known �_ OR Produced Identification
```�111iltltlfllll
Personally Known i( OR Produced IdentlABF
Type of Identification
Type of Identification
Produced
Produced STATE
OF
jl,-ii.14
TENNESSE
(Sig ature of No ry' Public- SWte ahoma
(Sig toe of Notary Public- State of Florida .7 <• Pi�BLiC .
Commission No.
a`,ps�/O
Commission No.® (Seow'.7
7
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