HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / T
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Date: 1_9' �G% % SCANNED Permit Number,
St. Lu e County
Building Permit Application JUN 19 2018
Planning and Development Services
Building and Code Regulation Division LPermitting Departmer
2300 Virginia Avenue, Fort Pierce FL 34982 tt ucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Re
PERMIT APPLICATION FOR: Medranieal " 1 1 A,h 1Z (. n
PROPOSED IMPROVEMENT LOCATION:
Address: b'tgo (_'Cf`)mefce r'eniner 1if
Legal Description: RESERVE COMMERCIAL TRACT W NORTH MAIN STREET VILLAGE PHASE I (PB 39-22) LOT B (1.344 AC)
(OR 1418-1820)
Property Tax ID #: 3327-803-0003-000-9
Site Plan Name:
Project Name: VILLAGE PANTRY CHEVRON
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
I NsxL� �1�� (S) FUEL_�kS EL_1S�S I QOVJ -
CONSTRUCTION INFORMATION:
❑HVAC ❑ Gad Tank ❑Gas Piping
❑Electric OPlumbing ❑Sprinklers
era
1-1 Shutters ❑ Windows/Doors
❑ Generator 1:1 Roof ❑ Roof pitch
Total Sq. Ft of Construction: _ Q• S Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer ❑Septic
Building Height:
OWNER LESSEE:
CONTRACTOR:
Name
Name: S mcVE-rl tJ pL_'—_
Address:1852 NW SAN SOLW4ST
Company: C ZE7NT-'oNE P c� MrorliR+tiC1D({S rN
City: State:FL
Zip Code: 34994 Fax:
Phone No.
Address: t33O �. ANo(z� wS Ave
City: Po N.PYNNo 6E_Ac-{+ State: f--C
Zip Code: 33aC9 Fax:
Phone No. 15 4- - -19 Z-- 1334
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Corvn
State or County License: ?cc 05(0819
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name: Koaercf W.1%•tn1Z-5um(, Name'
Address: (n12- LAwSmi STeeT_f Address: 1852UWSMSOUCIST
City: 5Q3ns-rrAJ Stater_ City: State:
Zip: 37-9 s8 Phone -"2-- 581- $-7Z"1 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
r"
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 contlict 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
commencin work or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
GL
STATE OF FLORIDA
OF "a-'i4elb
COUNTY OF r I[aae.
COUNTY -
The for qing Instrum nt was ac nowledged efore me
��Jdayouff
The forP,ping instrument was acknowledged before me
�' dayof TU/VF
this 20/ by
this .20!oby
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Name of person "ing statement
Name of perso making statement
ZV
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�_',(Q',
U
(Signature of Notary Public- St
(Signature of Notary Pub c-State of Floridaich )
1rRy"� TAMMYLYNN ouoUAY
Commission No. rMY(t a.1�SSIONtFFFB72176
MARIO A. GOMEZ
Commission Irig,'_� "__ pq�1pR#2
o< EXPIRES: June 1Z 2020
"oi '� EVRFS:Novam6Br4,2021
Ore,. Balled Thm Budget NolarySentes
•'•'•:{,"e1i.°P' BondedThm NOWr Pu6YcUrderWrb�s
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED
Rev.8/2/17