HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number:
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° ° e �� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial SIGN Residential _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone : (772) 462- 1553 Fax: (772 ) 462- 1578
PERMIT APPLICATION FOR : DUNKIN '
'F?ROP`QSED 111Y%If?RO�IIUIENT LQGATtO ( ^ , . . %.
Address : 903 E PRIMA VISTA BLVD , PORT ST LUCIE , FL 34952
Property Tax ID #: 3419-515-0001 -000-3 Lot No,
Site Plan Name : DUNKIN' Block No.
Project Name : DUNKIN '
TA1I E7 DESCRIPTIOU QF �/QRK:
INSTALL AND MAKE FINAL ELECTRICAL CONNECTIONS TO OPC/MENU BOARD COMBO
New Electrical Meter Second Electrical Meter
% GQNSIRIJCTION 1NFOR [VI�;TION:' %%
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
MElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq . Ft of Construction : Sq . Ft. of First Floor:
Cost of Construction : $ Utilities: — Sewer _ Septic Building Height:
.C?XNNER%LESSEE : % GONTRACTQR
Name ST LUCIE REALTY GROUP LLC Name : STEPHEN M KEMP
Address : 469 MARINER DR Company: KEMP SIGNS AND SERVICE , INC
City : JUPITER State : FL Address : 1740 HILL AVENUE
Zip Code : 33477 Fax : City: WEST PALM BEACH State : FL
Phone No. Zip Code : 33407 Fax : 561 -840-6385
E-Mail : Phone No 561 -840-6382
Fill in fee simple Title Holder on next page ( if different E- Mail PERM ITTING@KEMPSIGNS . N ET
from the Owner listed above) State or County License ES0000229
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 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 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 o otce of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signatur4fra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF G COUNTY OF PALM BEACH
Sworn to (or affirmed ) and subscribed b For 8e oin Sworn to (or affirmed) and subscribed before me of
J Physical Presence or Online oiric`�n XX Physical Presence or Online Notarization
this .LL14.Nay of SRC e'm6cc , 2 0 o ' this J day of CC�V0ID2 2020 by
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Name of person making statement. Name of person making statement.
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Personally Known _ OR Produced d' =on Personally Known XX OR Produced Identification
Type of Identification q •. �' Type of Identification
Produced VFf S \C2v� Se Produced �
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(Signature of Notary Public- tate of Florida ) (Signature of Notary Public- 'd
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Commission No. l� (Seal) Commission No. � ' I stzteor ca Florida
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTL
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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