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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d Ig-1 I L?� D Permit Nut
lR
`' Building Permit Applic� ion MAY 0 9
Planning and Development Services I ST.Lucie!County,Perm
itting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial yes Residential
PERMIT TYPE: Commerical Sigh
Address: 2801 North US Hwy 1
Property Tax ID #: 1428-501-0023-000-2
Site Plan Name: Metro by T Mobile
Project Name: Metro by T Mobile
face change to exsiting pylon sign
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
0
Cost of Construction: $ /o O Utilities: -Sewer —Septic,
Lot No.
Block No. _
Windows/Doors
_ Roof I Pitch
Height:
rs� fft S•r
t t }
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Name O USL FjI Q
Name David Clark
Address: X01 N US H-W y (
Company: Southeastern Lighting Solutions
City: PItru- State: r
zip code: 3y 94/o Fax:
Phone No. 964-1 C)1 15555
Address:821 Fentress Ct I
City: Daytona Beach I State:FI
Zip Code: 32117 Fax: 986-238-1300
PhoneNo386-238.171;1
E-Mail: YV1Pi"1 uPGTSibre0AJQJ011 c(Jd'1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail permits@southeasternlightindsolutions.com
State or County LicenseState EC12001826
I I
if vame or construction is , &)uu or more, a RECORDED Notice of Commencement Is required. -
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. ,�
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
I Not Applicable
i
Address:
Address:
I
City:
Zip: Phone
State:
City: i
Zip: Ph 6ne:
t State:
1
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
i
City:
City:
I
Zip: Phone:
Zip: Phone:
I
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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. I
St. Lucie County makes no representation that Is granting a ppermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associatlon rules, bylaws or and cover ants that may'restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which I may apply.
In consideration of the granting of this requested permit,) 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: roam additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another n ln-residential use
"WARNING TO OWNER: YOUR FAILURE TO. RECO A N E OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PR ERTY. A NO CE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SRE BEFORE THE Fill ST INSPECTION. YOU INTEND TO 9q IN FINA CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO R NOTICE OF COMMEN EM :'
f
Signa re of Owner/ Lessee/Contractor as Agent for Owner
Signa Contr ctor f o lr
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OFy olvSt
The for Ding Instrument was acknowledged befo a gib 1 n
The forgoing Instrument was acknowl Id d befor
V�l "O4A
this day of KwGg 20Q by w a �
this day of M Ck r c 20a Cby aarr
V10
A lit 9
al
Name of person making statement.
o d .o o
Name of person making stat ent. of 3
m
Personally Known OR Produced Identifi
tiorG r
Personally Known I OR Produced Identifcatio v
Type of Identification
Type of Identification i
I (
Produced
e N°oy.
Produced eb U
o �
(Si natu is -State of Florida)
(Signature of Notary Public- State of Florida )
�� 35�7zr Commissi n No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW)
REVIEW
REVIEW
DATE
j
RECEIVED
I 2C{
DATE
COMPLETED
Rev.2/i/Zy U