HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `S
Date: J��r �r uCU Permit Number: 1606/' 09
St. Luriacounty
RECEtVBD
fY MAY 3 p'71`118
Building Permit Application
Planning and Development Services PermutingSt. Luciea Co—'
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Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Yes Residential
PERMIT APPLICATION FOR: Other
Address: 1020 Shorewl Inds Dr, Ft pierce, FL 34949
Legal Description: See survey
PropertyTax ID #: 1425-701-0175-000-7 Lot No. 10
Site Plan Name: Block No. 7
Project Name: Cumberland Farms Shorewinds Canopy Replacement
Setbacks Front Back: Right Side: Left Side:
Construction consists of two new MPD fuel dispensers to replace the existing
including all connections between the dispensers and the underground storage tanks.
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0HVAC _ Gas Tank ❑Gas Piping
®Electric 1:1 Plumbing Sprinklers
Total Sq. Ft of Construction: NIA
Cost of Construction: $ 25,000
appry:
Shutters ❑Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: N/A
Utilities:Sewer 0Septic Building Height: N/A
OWNER%LESSEE � 3 P ?'CONTftxAC�TOR
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Name Vsh Realty Inc, Cumberland Farms Inc
Name: Gk6S U-1A
Address: 100 Crossing Blvd
Company: ee\ �CnS _ 1e&, J;SS149S
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city: Framingham State: MA
Zip Code: 01702 Fax:
Phone No.
Address: 4ysZ N'tUos Rfw *�Z
City: ZZACA<.SoN\I 'kk\e- State: Ft -
Zip Code: Fax:
Phone No. 90q- LEO- Og50
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: acul k -r- LX-'k,o+nyuel
State or Courant Licen�e: PCC0 569 3 to
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
snor, �� ��
SUPPLEMENTAL G N TR CCION`LIENIL I tINF®RMATION:
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DESIGNER/ENGINEER: _ Not Applicable
Name: Jeff Lucas. P.E. - Atkins. N.A
MORTGAGE COMPANY:
Name:
Not Applicable
Address: 7175 Murrell Rd.
Address:
City: Melbourne State: FL
Zip: 32940 Phone (321) 775-6647
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: 4 Not Applicable
Name:
BONDING COMPANY:
Name: TBD
_Not Applicable
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 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
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of Owner/ Lessee/Contractor as Agent for caner
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Signature of Contractor/License Holder
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STATE OF FLORIDA
COUNTY OF �J, 1(PJ11) t�/U
COUNTY OF /71I L58a2ouG f f
The for oing instrume was knowledged before me
this � day of�� 20B by
The for oing instrument was acknowledged before me
this 2�ay of�M�4 2018 by
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CAAVs I
L.I ity-A-S.
Name of perso aking statement
Name of peps n making statement
Personally Known V OR Produced aEj8ft"
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Personally Known OR Produced Identification
Type of Identification `,�{erM9
EI- 3� s
1.
Type of Identification
P uced �oh1M�E•io�%
Produced
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(Signature of Notary Public- State of-FlIN W'nature
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Commission No. 9qy PUtiv�OQ �`
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10
Commissio Eeal�9
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17