HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Building Permit Application
Planning and Development Services AUG 2020
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Peri;„I':tiot(j IDe ;;,i'L ient
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Re�sidEriLtial,,, G,.,, #y, FL
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 4780 N Kings Hwy, Fort Pierce, Florida 34951
Legal Description: 13 34 39 S 258 FT OF N 278 FT OFE 291 FT OF W 362 FT OF NW 1/4 OF SW 1/4(1.72 AC)(OR 1126-1398)
Property Tax ID#: 1313-322-0002-000-7 Lot No.
Site Plan Name: CVS Pharmacy Block No.
Project Name: CVS Pharmacy
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing roof system and install new per code
TPO Flat Roof(14207.1)
CONSTRUCTION INFORMATION:
Additionalworkto e e orme under t is permit—c ec a appy:
HVAC Ei Gas Tank 0Gas Piping _Shutters Q Windows/Doors
Electric E] Plumbing Sprinklers Generator Roof 1/12 Roof pitch
Total Sq. Ft of Construction: 11700 S . Ft. of First Floor:
Cost of Construction:$ 130,950.00 Utilities:)Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name CVS Pharmacy Name: Dee Keihn
,Address:4780 N Kings Hwy Company: PDKRoofing.lnc
City: Fort Pierce State:FL Address: 1299 SW Biltmore Street
Zip Code: 34951 Fax: City: Port Saint Lucie State:FL
Phone No.(772)528-0113 Zip Code: 34983 Fax:
E-Mail:PDKRoofing.lnc@gmail.com Phone No. (772)528-0113
Fill in fee simple Title Holder on next page(if different E-Mail: PDKRoofing.lnc@gmail.com
from the Owner listed above) State or County License: CCC1331408
1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 thepermit 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 ou intend to obtain financing, consult with lender or a attorney-before
com ncing wor or cord our Notice of cemgM
Pn
gnature'of /Lessee/Contractor as Agent for Owner Signature of Contr for/License HoVer
r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF «_ COUNTY OF 16N�' Guo—t-
The for oing instr e t was acknowledged before me The for oing instru ent was acknowledged before me
thiday of 20CC by thisaday of 20C L4O by
Name of person making statement Name of person making statement
Personally Known O-/_OR Produced Identification Personally Known 6� ` OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Q-2 &Zy 4��
(Signature INotary Public-State of Flori ) (Signature o Notary Public-State of Flori-a)
Commission No. trs!C? EXANDOW&IRRE Commission No. U1RR
E
.; MY COMMISSION#GG 234811 = �••'- MY COMMISSIOty tr GG 234811
poa EXPIRES:July 4,2022
'•? _off° EXPIRES:July 4,202
Bonded Thru Notary blo
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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