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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/29/2021 Permit Number:
RECEIVED
° JAN 12 2022
Building Permit Application St. Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: A(911wtxfAv"
PROPOSED IMPROVEMENT LOCATION:
Address: 121 S. Kings Fin, Ft. Pierce FL 34945
Property Tax ID #: 2311_-444--QDV4_--000-1 �,zti - b0k - CCOL _CC04 Lot No.
Site Plan Name: WAWA #5380 Block No.
Project Name: Orange Ave &Kings Hwy
DETAILED DESCRIPTION OF WORK:
Installation of Monument (17' OAH)CcD- Northwest Elevation (Orange Ave). Connect to
existing power.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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:
Cost of Construction: $ �3 Wh
Sq. Ft. of First Floor:
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
City: Orlando State: FL
Address: 4590 118th Avenue North
Zip Code: 32822 Fax:
City: Clearwater State: FL
Phone No. E-
Zip Code: 33762 Fax:
Mail:
Phone No (727) 573 - 7757
Fill in fee simple Title Holder on next page (if different
E-Mail angela.mcnutt(a1thomassign.com
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/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: ,,4, 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.
Lu ' County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi h I nder or an attorney before commencing work or recording our Notice of Commencement.
_VX I 171A 10 h —
ature� anus- or - Owner uil er as applicable
STATE OF FLORIDA f
COUNTY OF4-1 / AS
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
this a day of sA)NJ 20A_�by
F nkml b lA, 0. T�"Ofi*s
Name of person making statement.
Personally Kn V OR Produced Identification
Type of Ident' is ion Produ d
V'XV
(Signature of Notary P lic- State of Flor'
•`��tVP�''••. ANGELAMCNUTT
Commission No. (Seal) Notary Public - State of Florida
tea• Commission # HH 096693
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My Comm. Expires Mar 5. 2025
Bonded through National Notary Assn.
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DATE
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Rev 10/12/21