HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNED Permit Number: 46)/' das7
BY
St. Lucie County
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
PROPOSED.IMPROVEMENT LOCH bkc
Address: 900 Prima Vista Blvd.
RECE1V ED
APR 10 1018
permitting Department
St. Lucie County
Legal Description: River Park -Unit 34Second Replat Trad Alrss WLY M Port St. Lucie Bank and Less Beg at N LI Eaton's Or and W Li Entrada Av, Th WLY ALG So N LI 22026 FT toPOB
TH Cent WLY 135 FT, TH NLY 178.42 FT, The ELY 135.59FT. TH SLY 191.04FT to POB and less to first Fed Lake WoM as in or 308-2223 Map 3422S or 3570-1241
Property Tax ID #: 3419-525-0001-0004
Site Plan Name:
Project Name: ABC Medical, 3rd floor
Setbacks Front Back:
Right Side:
Electrical -Install 7 power poles at cubicles.
Low voltage -Install data cabling.
Left Side:
Lot No.
Block No.
CONSTRUCTaON INFORMATION
itiona wor TO De a orme un ert is permit—c ec a apply:
OHVAC MGasTank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 77 7.
S Ft, of First Floor: _
UtilitiestSewer Septic
Building Height: 4 stories
OV1/NER/LESSEE:
-. r:: 1F ; +
-CONTRACTQR
„,
Name Indian River Holdings LLC %John Martino
Name: Kenneth A Geremia, Jr
Address: PO Box 318
Company: Gerelcom, Inc.
City: Malverne State: NY
Zip Code: 11565 Fax:
Phone No.
Address: 560 NW Enterprise Dr. "
City: Port St. Lucie State: FL
Zip Code: 34986 Fax: 772-340-3666
Phone No. 772-201-0434
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: blanham@gerelco.com
State or County License: EC13001659
IT value oT construcuon is pA�uu or more, a 11m uxutu Notice or L:ommencement is required.
SUPPLEMENTAL'CONSTRUCTION LIENAA, INFORMATi(?N
x
DESIGNER/ENGINEER:
Name: Indian River Holdings LLc %John Marine
_ Not Applicable
MORTGAGE COMPANY:
N a me • Kenneth A Geremia, Jr
_ NotApplicable
Address: goo Pd.. Vista Blvd.
Address: P013oz318
City: MaNeme
Zip: Phone
State:
City: PortSt.Luue
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:55a NW Ent.Mnsa D,
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
ell
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF S% Lwc-%
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of . 20_ by
this ]Oc` tay of Z!h2(r L , 20 of by
KCnnC /A ; c ,Ytc .
Name of person making statement
Name of perso, making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
X c
(Signature of Notary Public -State of Florida)
(5' ature of Notary
Public -State
EANNE K MATTINO
Commission No. (Seal)
Commission No.G
COMMIb1 GG098938
EXPIRES May 28, 2021
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Rev.8/2/17