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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06-06-2019 Permit Number: T0%-0 15
SCANNED
BY
• St. Lucie County RF�Ervfo
Building Permit ApplicationJQ a &
Planning and Development Services Permitun 19
Building Code
Av3t Lnenue, Fort Pierce FL 34982 eDCOun y ent
2300Virginia P e
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMITTYPE: Sign
PROPOSED IMPROVEMENT LOCATION:
Address: 1020 Shorewinds Drive' Fort Pierce' FL
PropertyTax ID #: 1425-701-0175-000-7
Site Plan Name:
Project Name:
CUMBERLAND FARMS
Lot No. 10
Block No. 7
I DETAILED DESCRIPTION OF WORK: I
Manufacture and install one LED price board on existing gas canopy
Dimensions 2'- 4" x 11'- 0"' illuminated' right elevation'
Connect to existing electric provided by General Contractor
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
- lechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
v Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 25.67
Cost of Construction: $
1088.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height: 15'51/8"
OWNER/LESSEE:
CONTRACTOR:
Name Vsh Realty Inc. % Cumberland Farms Inc.
Name: Jeffery Adinolfe
Address: 100 Crossig Blvd.
Company: Atlas Signs Holdings Inc.
City: Framingham State: _
Zip Code: 01702 Fax:
Phone No.
Address: 1077 West Blue Heron Blvd.
City: West Palm Beach State: FL
Zip Code: 33404 Fax: 561-863-4294
Phone No 561-863-6659
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail gabriele.h@atlasbtw.com
State or County License ES0000204
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Theodore M. McAnlis, P.E.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: P.o.Bec14724
Address:
City: NadhP.1.8e.0 State: FL
Zip: 33a06 Phone661-663-6659#1462
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of eWssee/C fitractor as Agent for Owner
Signat r of ractor�, icense Holder
STATE OF FLO DP
STATE OF FLORIDA
COUNTY OF
COUNTY OF PG �t� �P q
The for oing instrument was acknowledged before me
this, day of .T�p . 20_o by
The for oing instrument was acknowledged before me
this 7r day of TU o f . 2011 by
r m 1 e
Tf--0--(�-I
n
t j FILMY :G:G
Name of person m ins statement.
Name of person m ng statement.
Personally Known `� OR Produced Identification
Personally Known OProduced Identification
Type of Identification
Type of Identification
Produced
-.s
Produced
(Sighs bre of Notary bljfy 5 to qtblgF y}eaSlaeot Florida
(Sign re of Notary Publi tit r 2�
.p*• td ublic State of Florida
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Gina Penney
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Gina Penney
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M Ce, 441 GG 122838
COmmIs5100 No. t y 99�12P
Expires 021
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Commission NO. n2S Mi �1erdI� ion GG 122836
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'�nr �&e Exp�e507l1012021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
loll
DATE
COMPLETED
Rev.2/7/19