HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�i)lfo UL CM �
°0�� _z 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
Address: 903 E PRIMA VISTA BLVD, PORT ST LUCIE, FL 34952
Property Tax ID #: 3419-515-0001-000-3
Site Plan Name: DUNKIN'
Project Name: DUNKIN'
Lot No.
Block No.
INSTALL AND MAKE FINAL ELECTRICAL CONNECTIONS TO ORDER POINT CANOPY
New Electrical Meter Second Electrical Meter
Additional workto
be performed under
this permit—checkall
that apply:
_Mechanical
_ Gas Tank
_ Gas Piping
_ Shutters -Windows/Doors _ Pond
❑✓ Electric
_Plumbing
_Sprinklers
_Generator _Roof Pitch
Total Sq. Ft of Construction:
$ _
Cost of Construction:
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE,
Name ST LUCIE REALTY GROUP LLC
Name: STEPHEN M KEMP
Address:469 MARINER DR
Company: KEMP SIGNS AND SERVICE, INC
City: JUPITER State: Ej
Zip Code: 33477 Fax:
Phone No.
Address:1740 HILL AVENUE
City: WEST PALM BEACH State: FL
Zip Code: 33407 Fax: 561-840-6385
Phone No 561-840-6382
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PERMITTING@KEMPSIGNS.NET
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
Name:
Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not
Name:
Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
IIIIIIIIIIIIIIIII
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in convict 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 attornev before commencine work or recordine vouAotice of Commencement.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed b
J Physical Presence or Online
this 2.0 day of �AoVe-M t_i' ,21
Name of person making statement.
Personally Known V OR Produced
Type of Identification ;.y
Produced ^
(Signature of Notary Public- State of Florida )
Commission No. IQ 2 (Seal)
Holder
STATE OF FLORIDA
COUNTY OF PALM BEACH
Sworn to (or affirmed) and subscribed before me o
nPhysical Pres rice or Online Notarizati �!.
this � day of m Z 2020 by `:;?roa,',�'
ham...
Name -of person making statement. 3 3 v
Personally Known xx OR Pr ed Identifica 0=
Type of Identification
Produced
(Signature of Mary Public- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.S/6/20