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ALL APPLICABLE I FOO7M ST BE C MPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 SCANNtu Permit Number: i 0�CX�
BY
st. Lucie Cni
Building Permit Application AUG d 7 2015
Planning and Development Services �� Public Works
Building and Code Regulation Division i 4t-. Weie county, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 C01mercial x Residential
PERMIT APPLICATION FOR: Concrete
"lPRWSED rMPROVEMENT`LOCATION
Address: 9675 Range Line Road, Port St. Lucie, FL 3496 --
Legal Description: See attached warranty deed
Property Tax ID #: 4201-113-0001-020/9,20t1N113 0001r01:0l6
Site Plan Name: Liberty Tire Recycling
Project Name: Liberty Tire Recycling
Setbacks Front 50 Back: 40 Right Side: 30 Left Side: 30
Construction of a bag house to existing Building #
&,e SFrue.� of ro. ear e2 siab 4 Consfrtcek., of o•.
el'r6b rtn lock)
Uk r ns v
Lot No.
Block No.
Aaaaionaiworxtooe errormea unaertnapermn—cneckan appry:
OHVAC _Gas Tank 11GasPiping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction �'� g S' S Ft. of First Floor: NA
Cost of Construction. $ 28;000---- - --Utilities:Sewer [;]Septic --Building'Height: NA
OWNER%LESSEE — =
vName
:CONTRACTOR
Liberty Tire Recycling- - - - —
Name: Ken Cook ►(eu iv% ewk
Address:1251 Waterfront Place, Suite 400
Company: Design Concrete and Masonry, LLC
City: Pittsburg State: PA
Zip Code: 15222-4261 Fax:
Phone No. 772-465-0477
Address: 1606 S.E. Village Green Drive
City: Port St. Lucie State: FL
Zip Code: 34952 Fax:
Phone No. 772-335-7915
E-Mail: kbloomer@libertytire.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: designconcreteandmasonry@gmail.com
State or County License: PSL14-4088!?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
•r
SUPPLEMENTALCONSTRUCTION'LIEN'L4W INFORtV1ATION;
'
DESIGNER/ENGINEER: x Not Applicable
Name: Florida Engineering and Design, Inc.
MORTGAGE COMPANY:
Name:
x Not Applicable
Address: 255 County Road 555 south
Address:
City: Bartow State: FL
Zip: 33830 Phone: 863-665-6363
City:
Zip: Phone:
State: FL
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY:
Name:
x Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
1. 5
�ignatu a of Owner/ Lessee/Agent
Si ture of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S'C L"t-le
STATE OF FLORIDA
COUNTY OF S' LxC- -P_
The forgoing instrument was acknowledged before me
this —n day of .NA VZ� _ 20 tl�_by
The forgoing instrument was acknowledged before me
this S`F-"-day of +�,tl�u`S'i" . 20 115' by
3\00r'-%e.4-
�r,N N Ve-o ill;
(Nam person acknowledgi�•ig/-�
(N(a a of person ackno edging )
(Signature of Notary Public- State of Florida) -- - -
-(Signature of Nota State.of Florida)- - _ -- -
Public-
-Personally'fin=V=0R` F6ducedIdentification
-Personally-Known ) - OR-ProducedAdentificatiorv--
=Type ofldentification Produced
Typ�€a Ydetttificatio rFrs u - -
- - EE ' O ARY PUBLIC
Commission No. a i
AAi�r' �j TARY PUBLIC
Commission No. EE �Z�74T'`• Q
`$}ATE
-
�."IE OF FLORIDA
IZt^'�'"?ComrtikEE182808
v.-� >� OF FLORIDA
1�=�., Comm#EE182808
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Revised 07/15/2014
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