HomeMy WebLinkAboutBuilding Permit Application_Signed_10.26.2021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/26/2021 Permit Number:
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�'Y Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial K Residential
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: US Hwy 1 Approx 160 ft. South of Riomar Drive
Property Tax I D #: Right of Way near parcel #3419-505-0005-000-0 Lot No.
Site Plan Name: JACKPT DOLLAR GENERAL Block No.
Project Name: JACKPT DOLLAR GENERAL
DETAILED DESCRIPTION OF WORK:
Installation of 100 amp, 1201240 electrical service for a small cell facility in the ROW, installation of pole covered under seperate ROW permit.
New Electrical Meter x Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: $ $1,801).DD Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Verizon Wireless
Name: Jonathan Crompton
Company. J. Crompton Electric Inc.
Address: 4700 Exchange Court, Suite 100
City: Boca Raton State: FL
Zip Code: 33431 Fax:
Phone No. 561-995-5723 E-
Mail: mark.b2esch2@verizonwireless.com
Address: 1290 Old Congress Avenue
City: West Palm Beach State: FL
Zip Code: 33409 Fax:
Phone No 561-202-4283
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail permitting@jcromptonelectric.com
State or County License SCC131151549
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.
SLIPPLFMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Telamon Name:
Address: 319 Chapanake Road, Suite 118 Address:
City: Raleigh State: NC City: State:
Zip: 276C3 Phone 405-348-5460 Zip: Phone:
FEE SIMPLE TITLE MOLDER: 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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-residentlal 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ L s ee/Contractor as Agent for Owrier
STATE OF FLORIDA
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COUNTY OF_I`��/'�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 2� day o{f, [ /n 202_L by
Name of person making statement,
OR Produced Identification
Type of Identification Prod
(Signature of Notary Public- Sta)k of F orida)
Commission No. (Seal) KVWPV Public Stste of Flanda
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SUPERVISOR
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VEGETATION
SEATURTLE MANGROVE
COUNTER
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REVIEW I REVIEW
DATE
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Rev 5/20/21