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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11.29.2017 Permit Number: 1307-0228
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 144 Mile Marker of the Florida Turnpike Service Plaza
Legal Description:
Property Tax ID #: 3431-122-0001-000-5 Lot No.
Site Plan Name: Port St Lucie /Fort Pierce Service Plaza Block No.
Project Name: Restaurant demolition
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
total demolition of the existing restaurant at the 144 MM of the Florida Turnpike
CONSTRUCTION INFORMATION:
Additional work to be) ormec Linder t ispermit — c ec a appy:
jer
HVAC L_J Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 18,500 5Ft. of First Fluor:
Cost of Construction: $ 85,000 Utilities:In Sewer E Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Florida State Turnpike Authority Name: Steven Greenberg
Address: 1211 Governors Square Blvd STE 100 Company: The BG Group, LLC
City: Tallahassee State: FL Address: 1140 Holland Dr # 19
Zip Code: 32301 Fax: City: Boca Raton State: FL
Phone No. Zip Code: 33487 Fax: 561-998-8815
E -Mail: Phone No. 561-998-7997
Fill in fee simple Title Holder on next page ( if different E -Mail: tiffany@bgdemolition.com
from the Owner listed above) State or County License: CGC1511135
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name: _
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: _ 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 thepermit 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 acco/e,,,,rn the pproved plans, the Florida Building Codes and St. Lucie County Amendments.
The folli permit applications are exempt from undergoing a full concurr cy review: room additions,
accessos, swimming pools, fences, walls, signs, screen rooms and access y uses to another non-residential use
WARNWNER: Your failure to Record a Notice of Commence ent may result in your paying twice for
improo your property. A Notice of Commencement m t be recorded and posted on the jobsite
beforeinspection. If you i to obtain financing, c suit with lender or an attorney before
commork or record i ur Notice of Commencem t.
Signature of Owner/ Lesse as Agent for Owner Signature of Contractor/License Holder
STATE COUNTOY OF FLORIDAj ,� , fl tir] _ PLC 1� STATE OF FLORIDA PgM ,� o
l� G'I—� I�� COUNTY OF
The jPg instro nt s ck wiedg fore me The f r ojng mstrui e t a a owled�e#ore me
this day of I�/ 1 � 20 this ��daay of + �t ' � ZO by
V &I
Name of person aking statement Nameof er on making statement-'
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification TIFFANY TOPCI
Produced Produced ,.1111 `•a
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notary Public - State of Florida
�� • t ` •' Commission # FF 929289
on)m. Expires Oct 20, 2{ 1
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nature of ry Publ C LioYitlB"'
(Signatur c otary Pu - lor,'� Ja
4 Nofa)y Public - State of FlotICommission
No. �(V710sion # FF 929289mission No.�/l/ (Seal)
My o m. Expires Oct 20, 2t
'•'�°";�'' Bonded through National Notary A. sr,
REVIEWS
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SUPERVISOR
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REVIEW
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DATE
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COMPLETED
Rev. 8/2/17
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PLANNING & DEVELOPMENT
BOARD OFy SERVICES DEPARTMENT
COUNTY
COMMISSIONERS "'7" Building & Code
-=- - Regulation Division
FILING OF STATE CERTIFIED CONTRACTORS
Please complete the following form and return the ORIGINAL signed and notarized to St.
Lucie County Contractor Licensing Department, along with the checklist below:
LICENSED QUALIFIER NAME
11-&nq Cl
COMPLETE
HOME ADDRESS
/ C
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HOME PHONE
E-MAIL ADDRESS
z-ACV&00— G 216.00d 11 f7M-
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BUSINESS NAME
C
UL,
COMPLETE
BUSINESS ADDRESS
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BUSINESS PHONE AND FAX
E-MAIL ADDRESS
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Please make sure that the Business Entity Namd, WorkeM"Compensation and Liability
insurance, all match the State Certified License.
1. Provide a Certificate of Insurance for Workers' Compensation and General Liability directly from
the Insurance Company with the certificate holder's address reflecting as follows:
St. Lucie County Contractor Licensing, 2300 Virginia Avenue, Fort Pierce, FL 34982
2. Provide a copy of the License provided by the Florida Department of Business and Professional
Regulation.
3. A clear copy of the qualifier driver's license.
Lice
Signature
STATE OF FLO�I A
COUNTY OF r tJ
The fregoing in§trume t w s ae nowledc
rd , day of �JIn V
nally known -to -Me br has produ
as
Signature of
ed befor this
—,20 11, by
who is
TIFFANY TOPCI
Notary e o1 Florida
Commission # FF 929289
Pp My Comm. Expires Oct 20, 2019
Bonded through National Notary Assn.
CHRIS DZADOVSKY, District No. I • TODD MOWERY, District No. 2 • LINDA BARTZ, District No 3 • FRANNIE HUTCHINSON, District No. 4 • CATHY TOWNSEND, District No 5
2300 Virginia Avenue • Fort Pierce, FL. 34982-5652 " Website: www.stlucieco.org
"CONTRACTOR LICENSING: (772) 462-1672' FAX: (772) 462-1148 Email: contractor licensing(a)stlucieco.org
• CODE ENFORCEMENT: (772) 462-1571" INSPECTIONS: (772) 462-2165 PERMITTING AND ZONING: Phone (772) 462-1553 FAX (772) 462-1578