HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: May 14,2018 Permit Number: 100 ' f
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Electrical
PR:Q €�Sf R�11RP( lElME1�tT LOCATION
Address: 260 SE Prima Vista Blvd. Port St.Lucie
Legal Description:
I
Property Tax ID#: Lot No.
Site Plan Name: Block No.
(Project Name: Wawa#5220
Setbacks Front Back: Right Side: Left Side:
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emporary Power. Building Permit# 1704-0135
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•Additional wor to a Ve. orme under tispermit—check a appy:
I=—IHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers FI Generator Roof Roof pitch
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Total Sq.Ft of Construction: S�of First Floor:
Cost of Construction:$ Utilities: Sewer OSeptic Building Height:
Name BW Prima Vista Floresta LLC Name: G.Mark Leib
Address: 3708 Swann Ave. Ste 200 Company: Accent Electric,Inc.
City: Tampa State: FL Address: 1045 N.Range Road
Zip Code: 33609 Fax: City: Cocoa State:FL
Phone No. 610 358-8000 -Zip Code: 32926 Fax: 321633-7397
E-Mail: Phone No. 321632-6067
Fill in fee simple Title Holder on next page(if different E-Mail: gml@accentelecbic.net
from the owner listed above) State or County License: EC0000874
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SJ�P�. hl1NTk.CtNSTRUCTION L'tEN tAVtl 1tt MAtQN
i
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:BW Prima Vista Floresta LLC Name:G.Mark Leib
Address:260 SE Prima Vista Blvd. Port St.Lucie Address: 3708 Swann Ave.Ste 200
City: Tampa State: City: Cocoa State:
Zip: Phone Zip: Phone:
j FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:1045 N.Range Road 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 Count 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 1 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 you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
a
i Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contract r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 9cA;,., COUNTY OF I3r-eyeti-S
The forIgg��o��ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this may of mlui 20 1� by this,JLday of M cuA 20A by
eve t � G• n -
Name of pers n making statement Name of pers making statement
Personally Known V OR Produced Identification Personally Known % OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ignature of NotaryP (Signature �h„
JODILPETERSON ;:*•;� DEANN E LEIB
Commission No. rw Notary State of �' mmission FF 9
Commissio i Co.-
CommrssionriGG072280 y ommission Expires
= o�c My Comm.Expires Feb 12,2021 $ n„a•``8 June 01, 2020
°FFl00 Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
_T
COMPLETED
Rev.8/2/17