HomeMy WebLinkAboutFt. Pierce Permit App 5-3-2021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTED
Date: 02 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial xxxx Residential
PERMIT APPLICATION FOR: Billboard PSL, LLC
PROPOSED IMPROVEMENT LOCATION:
Address: 10961 US-1, Fort Pierce, Florida 34952
Property Tax ID #: 3414-501-5016-000-8 Lot No._
Site Plan Name: Block No.
Project Name.
DETAILED DESCRIPTION OF WORK:
'o
New Electrical Meter / Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check
all that apply:
_Mechanical — Gas Tank _ Gas Piping
Shutters Windows/Doors Pond
LLIflectric _ Plumbing — Sprinklers
_ Generator _ hoof Pitch
Total Sq. Ft of Construction-
Sq. Ft, of First Floor:
Cost of Construction: $ o Q. Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Billboard PSL, LLC (easement owner)
Name- � �%t /J C�ip rri e
Address: 49 SW Flag ler Ave., Suite 301
Company: �lr� _Zyr� L�01�c /'!1=J ,LI1C
City: Stuart, FL State:
Address: a1 � � W �S /7�� S f i4' ej C 7
Zip Code: 34984 Fax:
City: ?I#'/!'t Z�v2 v�- State:��
Phone No. 772-286-5744
Zip Code: 3 Y6 i'.3 Fax:
E-Mail:mkoblegard@eomrnercialrealestatellc.com
phone No �S 6 ,� 0 7 1�5— r V
Fill in fee simple Title Holder on next page ( if different
E-Mail e q� C-1 /f r %41 rr /' 1 C
from the Owner listed above)
State or County License Z O D
If value of
-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: ` Not Applicable
Address: Name'
city: State: Address:
City:
Zip: Phone State:
-- -- Zip: Phone:
FEE SIMPLE TITLEHOLDER: , Not Applicable BONDING COMPANY: Not Applicable
Name: G=bha 732a, LLC
Address: 7WO S US 1 NArne'
Address:
City: Port SF. Lucie
Zip:3assz Prone: City:
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 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 !e r or an atv before commencing work or recor n your Notice of Commencement.
SignOt4fe of Owner/ Lessee/Contractor as Agent for Owner
STATE OF �\.A W- F �
COUNTYOF
of Contractor/License Holder
STATE OF fiftft �k-L,5
COUNTY OF_ i 'v-)
Swor o (or affirmed) and subscribed before me of Swor (or affirmed) and subscribed before me of
�. Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of t`5 1 149ffby this lip day of ' �AW by
CL
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification _� Personally Known OR Produced identification L/
Type of identification Type of Id tifigation _
Prbduced �� �'c PQ� PI
uced ; �,
(s� . ' Z�n
of Nlolary Public- State
Commission No. I�Lb� � 6 P10-3
REVIEWS I FRONT ZONIA
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLET
tuC' 1 (Signature of t4&a[ry Public- State of f
CAROLYN MCLC NCommissi n No. f STROLYN MCLEAN
Notary Public - Stale of N w Jersey Notary Public - State of New
My Comrr o rra i
:rpires�
VEGETATION SE
REVIEW REVIEW REVIEW REVIEW REVIEW