HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 9 I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
' Date: Permit Number: ()h7
W" -IS,
Building Permit Application
Planning and DevelopmentServices
Building and Co&,Regulation Division Commercial X Residential
I 2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578
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PERMIT APPLICATION FOR-MARATHON
Address: 1200 W MIDWAY RD, FORT PIERCE, FL 34982
Property Tax ID#: 3404-501-0322-000-0 Lot No.
Site Plan Name: Block No,
Project Name:
: { -
INSTALL CANOPY GAS PRICER FAST
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
_Mechanical W Gas Tank _Gas Piping _Shutters -__ Windows/Doors _Pond
�✓ Electric _Plumbing Sprinklers "Generator _Roof pitch
Total Sq. Ft of Construct'o Sq. Ft, of First Floor:
Cost of Constructio :$ Utilities: _Sewer Septic Building Height:
Name SHUKLA ENTERPRISE: INC 'Name:STEPHEN M KEMP
Address.2300 BELL AVE Company:KEMP SIGNS&SERVICE INC
City,: FORT PIERCE, State:_ Address:1740 HILL AVENUE
Zip Code: 34982 Fax: City: WEST PALM BEACH State.'FL
Phone No. 33407 561-840-6386
Zip Code: Fax:
E-Mail: Phone No 561-840-6382
Fill in fee simple Title Holder on next page(If different E-Mail PERMITTING@KEMPSIGNS.NET
from the Owner listed above) State or County License ES0000229
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.
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P - Not.A ..livable _
bESIGNER/ENGiNEEf� _ , pp MORTGAGE COMPANY, Not Applica,bfe
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.Name; Name
Address-: _ . Address:.
City: state: City: State:
dip: Phone :. Zip: Phone;
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iESIMP"LETITLE`HOiLDERt _:Not Applicable BONDING.COMPANy: _Not,Appiieabis
'Name:. Na"nte
Address; Address'
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City: City: -
Zip: Phone: Zip:- Ohone:-
ApPlitat1 n N hereb ,:made;to,obtaln a.,eri-nit.to do the.*grk.and jhStallatlon as:fndicated.� I
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certify that nawork-or°installation has"commenced'prior.to the issuance of a permit-.'
St.Lucre Countyy makes'no representation that.Is granting a ppermit will authorize the e'n1j' holder to build the subject structure,,
which IsJri`cdh lid with�;i yapplicable Home Owners Association�rules;bylaw"s_or an covenants that.may restnct or prohit it such
structure.Please consult with your Borne Owners Association and:review your deed?or'any restrictions which may apply:
In consideration of the granting of this requested permit;]do hereby agree thaf i.wlll,in-all respects,perform the yvork 1
in accordance with'the approved p)ans,,the Florida Buiidlrig Codes and'k Lucre County Amendments.
The following building permit applications are exempt`frormun lergainga'full concurrency review:room;additions i
accessory.structuees„swinimfng pools,fences,walfs,signs,screen,rooms and aceessory_,bsesto,anoiher non-resldentfai>use
WARNING TO OWNER:yuur'failure to Record.a,Natice,of Cominencement•m'a-"result irrpaying twice:for 1
improue rients to your.property A Notice,ofCommencement must be.recorded in the-public records of St.
l;uc►e County'and"posted on•tihe jobsite before the first inspection.,If 'Intend to,obtain flhancing-"consult I
with lender or a " before cornmehein .work or recardin . Notice..of comrnenceie!hti11/Of
5lgnaturel7nNneiJL sse act6rasAgenEfor;,utner7° signa'tii6eof ira.etor/.License.H.older1 q
STATE QF LORIDA :� STATE OP FLORIDA
COUNTY C3F - COUNTY OR : 1rn 7&we'l
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Sw".rn to(ot affirmed)and subscribed before me of Savor o(or affirmed)and subscribed.before.me of. i
l Ph ical Presence or Online.Notarization Phy'ical Presence or Online Notarization,
this, day of ir} :C¢ n.,�.P;� 202( by thisiay
—,� y�l — 28'ttl b' i
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Name ofpersori making staterrrent: N ry�— Name of person making statement. '
Personally Kriown pR;Producedldentlfication Personally Known 1/ OR Produced Idenfifliatlon
Type'of Identification: Type otldentificatlon
�PTodceed
Prod "uc
ed.
vismWUNS
(Signature•af A6t4rVV,P 2.-: CiG368t53; {Signature of No Public a orl a
E1Zpii86k0V8it1Q0r12i S P�e MARIAC pAMIANI
On6ortfke8i14,�E6,TOSO ?° � a� N(tary� 1ic State of n6rfd
Commission No,.
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, ffitf mmission No. o $�a issian:-GG9RSQ44.
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'••.„off My:Comm,;Expires,Jut 14 202.,
od'
Boo ed throw h National�46tar/"Ass .
REVIEWS FRaNT IONiNd SUPERVISOR PLANS" VEGETATION 5EA•TURTLE fVIANGftO,VE
COUNTER' REVIEW EtEVIEW REVIEW _REVIEW REV,IEVV: REVIEW
DATE
RECEIVED
DATE _
COMPLETED
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