HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED APPLICATION-TOPTED
Date: \ Perm Number: :)
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Planning and Development Services
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Building and Code Regulation Division
St. Lucie
2300 Virginia Avenue, Fort Pierce FL 34982 Coun]y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 903 E Prima Vista Blvd. Port St. Lucie FL 34952
Legal Description: River Park -Unit 3- E 388.35 FT of Tract D as measured ALG the NLI of SD Tract (map 34/22s) (or 2622-1580 THRU 1592)
Property Tax ID #: 3419-515-0001-000-3 Lot No.
Site Plan Name: Block No.
Project Name: Dunkin Donuts Prima Vista PC#353506
Setbacks Front Back: • Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Interior tenant improvement to existing commercial building.
CONSTRUCTION INFORMATION:
itiona wor to e e orme under t—checkispermit a apply:
ZHVAC E] Gas Tank []Gas Piping _ Shutters Windows/Doors
Z✓ Electric ❑✓_ Plumbing Sprinklers ElGenerator 11 Roof Roof pitch
1838,sgr" 7 1838 ft
Total Sq. Ft of Construction: S Ft. of First Floor: sq
Cost of Construction: $`t=0•L'4?� Zyg,n1.Cf— Utilities: Sewer Li Septic Building Height:23'
OWNE L SSEE: CONTRACTOR:
Name FW Donu s LCt
Name: Matthew Mattison
Address: 2642 SE Willoughby Blvd
Company: Commercial Contracting Divisions, INC
City: Stuart State: FL
Address: 709 SE 5th Street
City: Stuart State: FL
Zip Code: 34997 Fax:
PhoneNo._ 0d) aaS—Ii-(a7
Zip Code:34994 Fax:772-283-2855
E-Mail: Ej:Q$ e& a 011Y/'1?4c4r tiK& , (eW"
Phone No. 772-220-3488
Fill in fee simple Title Holder on next page ( if different
E-Mail: AUaraway@ccdofstuart.com
State or County License: CGC1525229
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTIOid Ui N
LAUV iNFORMA�GEON
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
r�Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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."
Signat e 6f Owner/ Lessee/Cq tractor as Agent for Owner
STATE OF FLORIDA t COUNTY OF ,6, . 11Ct, lF ,
The forgoing instrT;m t was acknowledge before me
this AL day of T\ 20by
Name of person making statement. /
Personally Known OR Produced Identification ✓
Type of IdentifF itien
Commission
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Signa l re of Contractor[L dense Holder
STATE OF FLORIDA l UC�E
COUNTY OF l
The forgoing instrulnenj was acknowledged efore me
this L day of \ — I 20 ' by
C l I) �IA41<�80
Name of person making statement.
Personally Known OR Produced Identification
Type of
a(�t�,y is-. A1AE gn"� LSEN
. ^
(Signature of NotaryP�
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r State of Florida -Notary Public
•= Commission gT41511207484
Commission No.
My Commission Expires
June 12, 2022
FRONT
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