HomeMy WebLinkAboutBuilding Permit Application rt All APOLicABLE,INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (
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..Build-in ''Perhi t'APPlicatiori
Planning and Development Services
Building and Code Regulation DiVision Cbmfiliercial ,YES Residential
7300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462'1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: 'DOLLAR GENERAL''``"
'Address: 3761'VIRGINIA AVE FORT PIERCE,FL 34981
Property Tax ID it: 420 2ZI— 00o l oW11, Lot No.
Site Plan Name:. Block No.
Project Name; DOLLAR GENERAL VSAT
DETAILED'DESCRI'PTION OF WORK:
INSTALL-SIMPLE SATELLITE DISH FOR POS SYSTEM!INSTALL DUAL RG11 COAX CABLE
New Electrical Meter. Second Electrical Meter
CONSTRUCTION-INFORMATION:
s '1014,onal work to be performed under this permit=check all that apply:
qq � Jlechanical Gas tank Gas Piping _Shutters Windows/Doors Pond
X Electric _Plumbing _Sprinklers Generator Roof Pitch-
w fatal 4.Ft of Construction: Sq.Ft,of First Floor: t
�+ At 1000.00 a
x' r Cost=of`'Construction:$' -Utilities: Sewer Septic Bwlding Height:�-
,�.7 , ,' Y
I.
3 h OWNER/LESSEE: CONTRACTOR: a r
SC FORT PIERCE,LLC HAYMES SNEDEKER ;
[ .1.. ." .; � Name:- -"Jirnmy,G Pace
re>;s:PO BOX 130 Company: Power..ElectrlcConstruction, Inc.., F
' Ci`yPHNE � `'4 .'Siate:' Address-0588 Collier Road
Zip Code: 36526 Faz: City: $t Augustine
'Stater F�
251-243-,070B
Phone No. Zip(ode:-32092 Fax:
E TVfail:HAYMES@HIXSNEDEKER,COM Phone No 904-626-1425
Fill in fee simple Title Holderon next page`(if,different E-Mail: jgp mp I1lSJr1.00111
fromthe Owner listed above): State or County`License EC0000994 ,
If value of construction is 2500 of more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,SdO or more,a RECORDED Notice of Commencement is required.
- 1
SUPPLEM:ENTAL'•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:
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 Associationrules,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 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
wi lender.or a before commencin work c rdin once ommencement.
2/X
Sign re o Owner Lessee/Contractor as Agent for Owner ature of Contract-or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Johns COUNTY OF
St Johns
Sworn to(or affirmed)and subscribed before me of Syvorn to(or affirmed)and subscribed before me of
X Physical Presence or Online-Notwization.-- JC Physical Presence or Online Notarization
thisl$jbday of- March 902 by this 8thday of March by W
; . my G Pace Jimmy G Pace
=� a of person making statement. Name of person making statement.
o`'•• .r'Sc`. XX o
n Pe nally Known. XX OR Prod uced'ldentification Personally Known OR Produced Identification E
a of identification T entification tu
guced Produc u.
NQ
m .z
il nature of Notary Public-State or Florida) (Signature of Notary Public-State of Florida)
2
.mission No. O 3 Z� (Seal) �Commission 4�0.� Z � tSeal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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