HomeMy WebLinkAboutPilot Flying J Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
��T'LUGU
L ' L Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 8699 100 North Kings Hwy. Fort Pierce, FL 34945
Property Tax ID #: 2312-231-0003-000-5
Site Plan Name:
Project Name: Flying J #622 - Island Cooler Installation
DETAILED DESCRIPTION OF WORK:
Refriqeration installation of 1 island cooler with remote condensing unit on roof.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No._
Block No.
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3565.00 Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameCFJ Properties
Name: Bryon Miller
Address: PO Box 54470
Company: Coastline Cooling, LLC
City: Lexington State: k
Zip Code: 40555 Fax:
Phone No.
Address:7697 SW Ellipse Way
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No8773826363
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail service@coastlinecooling.com
State or County License CAC1815840
it value of construction is Z500 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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Citv:
Zip: Phone
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
te:
FEE SIMPLE TITLE HOLDER: _ 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 inaicateo.
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 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
.,;+h Ior r4nr nr nn n+tnrnav hafnrA rnmmanrino wnrk nr rPr.ordinE your Notice of Commencement.
Signature" of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORI A
COUNTY OF M ,2_,A I N
COUNTY OF N aAA I i1
S rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
� Physical Presence or Online Notarization
this day of 2oz� by
this day of t 1_ 202f by
1 Ana I�rad It i,
Name of person m king statement.
Name of person Making statement.
Personally Known Q_ OR Produced Identification
Personally Known T— OR Produced Identification
Type of Identification
Type of Identification
roduced
Produced
(Signature of Notary Public to
r +., •; DANABRAD
of Notary Public- St
T. pANABRAD
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Commission No. C-)6�sl
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M?ssi No. b��?SIL49
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EXPIRES: June
=,';� EXPIRES: June
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sOF RL�.. Bonded Th. Notary Pub
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• ,OF FL,P Bonded Thru Notary Publi
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
149