HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 12-29-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/29/2021
Permit Number:
RECEIVED
Building Permit Application JAN 12 2022
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
CBDG Funding
PERMIT APPLICATION FOR: OA-S 0010e� Db S
PROPOSED IMPROVEMENT LOCATION:
St. Lucie County
Permitting
Address: 121 S. Kings Hwy, Ft. Pierce, FL 34945
Property Tax ID #: 2311 4y1 000-1 ;Z`?a41 Upl CM2,.- OQ09 Lot No.
Site Plan Name: WAWA #5380 Block No.
Project Name: Orange Ave & Kings Hwy
DETAILED DESCRIPTION OF WORK:
Installation of: Canopy Sign (16" CL) @ Northeast elevation, Connect to existing power.
Canopy spanners (x2) @ North & South elevations.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ � ; 3 --
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer —Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name WAWA Florida LLC
Name: Priscilla Thomas
Company: Thomas Sign & Awning
Address: 7022 TPC Drive Suite 200
Address: 4590 118th Avenue North
City: Orlando State: FL
Zip Code: 32822 Fax:
City: Clearwater State: FL
Phone No. E-
Zip Code: 33762 Fax:
Mail:
Phone No (727) 573 - 7757
E-Mail angela.mcnuttCc@thomassign.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License ES0000083
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.
I,"SUPPL'EMENTAL CONSTRUCTION. LIEN LAW INFORMAT,ION:-"
GNER/ENGINEER: _ Not App
Name: Jack Dougherty
Address: 4590 118th Avenue North
City: Clearwater State: FL
Zip: 33762 Phone (727) 573 - 7757
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: BP -OK DEV. LLC
Address: 20411 W. 12 MILE Unit Ste 200
City: SOUTHFIELD: MI
Zip: 48076 Phone:
MORTGAGE COMPANY: ,R4, Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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 the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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
wit'rp li?nder or an attorney before commencing work or recording your Notice of Commencement.
Vk1 A
�Sig.raature ofiConttattC7 - or -Owner uilder as applicable
STATE OF FLORIDA f I
COUNTY OF I Ku l as
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
_
this .3 day of A&S 20a- by
P r� sU NA am &-s
Name of person making statement.
Personally Known d OR Produced Identification
Type of IdenrX
(Signature of Notary Pu Ic- State of Florida)
104,ANGEiA MCNUTT
Commission No. (Seal) r?°!4' Nota aublic State of Florida
'•: rY
s` Commission HH 096693
My Comm. Expires Mar 5, 2025
Borcec through National Notary Assn.
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