HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'9( -
OFFICE,USE ON_ LY:
DATE MD:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
3�RMIT NUMBER I O U7O
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUH,'nD'ING & CODE REGULATIO DIVISION
SCANNED 2300Avenue Ft. Pierce, F34982-5652 WM �BY 762-1553
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APPLICATION for BUILDING PERMIT `77 0 C.
CERTIFICATE of CAPACITY/ZONING COMPLIANCE /
PROJECT INFORMATION
I. LocATIONisrrE ADDRESS: 301 Prima Vista Boulevard, Port St. Lucie, FL 34983
2. PROJECT NAME: CVS Pharmacy #4254 SITE PLAN NAME: CVS Pharmacy #4254 Pt. St. Lucie
3. PROPERTY TAX ID #: 3419530-0219-000-1
4. LEGAL DESCRIPTION (attach extra sheets if necessary):
River Park — Unit 4 Block 39 Lots 33, 34 and 35 (Map 34/28N) (or 939-320)
5. PLAT BOOK 11 6. PAGE NO. 9
9. PARCEL SIZE (ACRES/SQ FT.): 1 /8,857
7. BLOCK NO. 39
LOT DIMENSIONS:
S. LOT NO. 33 - 35
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
Exterior work at Parking lot- Front of the store: Handicap Parking spaces modifications to comply with ADA Standards.
Ramp at Accessible isle to be eliminated 8r side walk to be flushed with isle.
11. SETBACKS (ACTUAL) FRONT: / BACK: �� RIGHT SIDE�G LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL 0 COMMERCIAL [ ] INDUSTRIAL
❑✓ OTHER (SPECIFY) Exterior work at Parking lot. Handicap Parking spaces modifications to comply with ADA Standards,
13. DESCRIPTION OF PROPOSED USE: StOre/Retail/Pharmacy (Same as existing)
14. SQ. FT OF CONSTRUCTION. 15. SF. FT 1st FLOOR
16. VALUE OF CONSTRUCTION: $ r V(Do
The value of construction is used to determine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
J
OWNER INFORMATION
NAME: Leatherwood Compan
ADDRESS: 505 9th Street N.W., Suite 1000
CITY: Washington STATE: DC ZIP: 20004
PHONE (DAymm): 2( 02) 776-7831 Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL, IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER N/A
ADDRESS: N/A
CITY: N/A STATE: ZIP:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. ofFL REG.CERT #: (' C7C 45CN444'�) ST. LUCIE COUNTY CERT #:
BUSINESS NAME: -K11)P_S(IYriP_ lM(r'fn]t hCn
QUALIFIERS NAME: i (l 'iV Can ''
ADDRESS: �� (p p N�_I ? `(
CITY: e yfcc.P S n 2-,DN4 STATE: f2 ZIP:
PHONE (DAYTIME): ( !3�t.S-(041(o FAXNO.L%S+34-WWEmaii: RobinAQWesaw—u7nSb�
ARCHIT/ENGINEER Robert Reid Wedding Architects & Planners (RRW)
ADDRESS: 612 S. Military Trail
CITY: Deerfield Beach STATE: FL Zip: 33442
PHONE (DAYTIME): (L54) 428-9361
BONDING COMPANY: N/A
ADDRESS:
CITY:
MORTGAGE LENDER N/A
ADDRESS:
CITY:
STATE:
STATE:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
1
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE 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 YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TIME, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
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OWNER 46R CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
stru rent was acknowledged before
'�a� of 20
einpr�'�:'®.
aXI�O prso]wl rOPB _ or has produced
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DISTRICT =ddeuggi Alin.
SUBSCRIBED AND SWORN TO BEFORE METHIA
sign a of Notary
STATE OF FLORIDA^
COUNTYOF IiLY
The foregoing instrument was acknowledged before
me this 'T''S /day of A041 201�
by RObrn . -1 ea-n
who is personally known _�_/or has produced
as identification.
No. P'!*-Zb CARHERRY
* * AIYCOMPSIOtdiDD952964
EXPIRES: February 12,2014
'r .Mlv`O Banded TIuu Budget Notary Services
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUI.DER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
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OFFICE USE ONLY BP #: 1 3 " QMQ
SECTION
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RANGE
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MAP NO.
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ZONING
LAND USE
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FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before l/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BID
PUBIC BID
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
FEE
CORRECTION
FEE
'FEE
SCHOOL
—
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
-CONFORMING
MISCELLANEOUS
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SUBS
_
ELECTRIGAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING,,FEES
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DATE SENT TO ADDRESSING: �/_/
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