HomeMy WebLinkAboutlight pole permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : 12/15/20 Permit Number: ________ _
Planning and Development Services
Building Permit Application
Building and Code Regulation Division Commercial ____ _
1300 Virginia Avenue, Fort Pierce FL 34981
Residential ____ _
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Sight lighting
.PR0P0Sj D IMPROVEMENT LOCATION: -
Address: 7310 indrio rd
Property Tax ID#: 1314-144-0000-000-0 Lot No. ___ _
Site Plan Name: _________________________ _ Block No.
Project Name: 7-11 store number 38944
_D.
8 light poles with bases
New Electrical Meter ____ Second Electrical Meter, _____ _
• ..;..'l .. :n-CONS"Ff\tl.CTIQ _
Additional work to be performed under this permit-check all that apply:
Shutters _ Windows/Doors Pond _Mechanical
Electric
Gas Tank
_Plumbing
_Gas Piping
_ Sprinklers Generator Roof ____ Pitch
Total Sq. Ft of Construction: _______ _ Sq . Ft . of First Floor: _________ _
Cost of Construction:$ _______ _ Utilities: _ Sewer _ Septic Building Height: ___ _
Name lndrio Retail Properties,LLC
Address: 2129 Via Fuentes
City: Vero Beach State:
Zip Code: ..:3c::2.::.96.:..3:__ ___ Fax:. _______ _
Name:Rob kennedy
Company: Wilsons Petroleum
Address: 1803 south 31st
City: Ft pierce State:.!2_
Phone No .. ______________ _ Zip Code:_3_49_4_7 ____ Fax: ______ _
E-Mail: _______________ _ Phone No 772-468-3689
Fill in fee simple Title Holder on next page ( if different E-Mail robk@wilsons-petroleum .com
from the Owner listed above) State or County License. __________ _
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE R/ENGINEER: _ Not Applicable MORTGAGE COMPANY: .:._ Not App lica bl e
Name :M•O AT1&1"'"°" Name :
Address : 192s~ ..... Address :
City : ,.,.,,,., State:_A __ City : State : --
Zip : J1a1.i Phone ,10166 111100 Zip : Phone :
FEE SIMPLE TITLE HOLDER : Not Applicable BONDING COMPANY : !._Not Applicable
Name : Name :
Address : Addre ss:
City : City:
Zip : Phone : Zip : Phone :
OWNER/ CONTRACTOR AFFIDVIT : Application Is hereby made to obtain a permit to do the work and inSlalla~on as 'nd 'cated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
Sth~icje .coun~imakes no representation that ls granting a permit will authorize the germit hold eh to buil d
ti~~se ~~i:~,f ~ttPf J~~,~~~~!~:~t5s~a'tc~t~on"l~~~e!Y:~~ 3::s to~0a'-;v"t:sii1lJ~;Y~~ may apply.
In consideration of the granting of this requested permi~ 1 do hereby agree that I will, in all respects, perform th e work
1n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments .
The following build ing 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•resldential use
WARNING TO OWNER: Your failure to Recond a Notice of Commencement may result in paying twic!' for
improvements to your property. A Notice of Commencement must be recorded in the pu~hc re.cords of St.
Luc ie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencin work o ordin our Notice of Commencement.
STATE OF FLORIDA COUNTY Of---'{.;"'e:.::e.::;_ _________ _
sjrn to (or affirmed) and subscribe? before ~e of
__ Physical Presence or Onhne Notarization
this ~ day of (X~e,.,w" , 2020 by
,N\qti~ew /2.o55
Name of person making statement.
Personally Known _LOR Produced l~,~1111119,"1;;--
Type of Identification '!\.,,,..._ ~\-\ HENr11, .,..,~
Produc f pej.~·· .. o~'\
J~ f /~\<o1'29·"i·t\
(Signature of Notary Public-State o£ orl;qil ks : = 7 3, s-% ~."·\. 917365.)-• ,'ff J Comm ission No. GG'f/ ~~e~h1~•·· <f~ Pa ••••••
;,"".1111 '8Lfc, STA1l tu\,,,~
STATE OF FLOR!J2!' (' ..-COUNTY OF -2:/: ( I.(,/ &
S~to (or affirmed) and subscribed before me of
__ Physical Pres;i,ce _or ___,,_ ()~lin, Notarization
lhis/}....:_dayof~li.JL__=~===~~' 020 by
°(0J/Mtr -r . K.eD Vn:>'f
Name of person makiyatement.
Personally Known ___ OR Produced Identification _!}_&_ !~~• o:.ltntification ;J fr
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SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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