HomeMy WebLinkAboutBuilding Permit Application 03/01/2017 1:19 PH FAX 7723372699 KENT—BLOSSER IM 0001/0002
ALL APPLICABLE 1 FO MUST BE COMPLETED FOR APPLICATION TO BI ACCEPTED
Date: c f4cd I I Permit Number: d 3' 033
Building Permit Application
Planning and Development Services
8ullding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial XX Residential
PERMIT APPLICATION FOR: Electrical
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Address. 7149 S US 1 Port St Lucie,FI
Legal Description:
Property Tax ID#: 3422-211-0010-000-6 Lot No.
Site Plan Name; Block No.
Project Name: PSL Plaza
Setbacks Front Back: Right Side: Left Side:
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Re-energize Electric to building
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Additional work oOrme under this permit—c ec a apply:
HVAC rlasTank Gas Pipin _Sh Iters E�~`]�Windows/Doors
❑ 8 �1 , Dors
Electric Plumbing ❑Sprinklers IlGe orator 0 Roof Roof pitch
Total Sq.Ft of Construction: _ SFt.of Fl st Floor:
Cost of Construction:$_J Qb jaV Utilities:11Sew r EJ Septic Building Height:
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Name Port SL Lucio Plam t,II,III LLC Name: Ker t Blosser
Address:112 Physis Ct Company Blosser Electric
City: Elmont State:NY� Address: PO Box 7305
Zip Code: 11003 Fax: City: Port t Lucie State:Ff
Phone No. Zip Code: 985 Fax: 772-337.2699
E-Mail: Phone No. 772-337-0055
Fill in fee simple Title Holder on next page(if different E-Mail: nrblosser@gmaii.com
from the Owner listed above) State or County License; EC13001670
If value of construction is$7500 or more,a RECORDED Notice of Commencem nt is required.
03/01/2017 1:19 PM FAY 7723372699 RENT—BLOSSER 1@0002/0002
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DESIGNED/ENGINEER: i Not Applicable MORTG WE COMPANY: Not Applicable
Name: Name:
Address: Address
City: State: City: State:
Zip: Phone: zip: Phone:
FEE SiMPLE TITLE HOLDER: � Not Applicable BONDIN COMPANY: • _,_Not Applicable
Name: Name
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucle Coun makes no representation that is granting a permit will authors a thedpermit holder to build the subject structure
which)s In conflict with any,applicable Home Owners Association rules,bylaw or an 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 th t i will,In all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luci County Amendments.
The following building permit applications are exempt from undergoing a full c ncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements tn.y .roperty.A Notice of Commencement mu be record and pasted on the jobsite
before the first irl5pe�on.If you intend to obtain financing,cons it with.tend or an attorney before
commencir� 'work ar`recardin ur Notice of Commencement.
5ignature of Owner Lessee Contractor as Agent for Owner signature of Contractor License Molder
STATE OF FLORI STATE OF LORIDAj` �.2..�
COUNTY OF / COUNTY F_
The fior ping instrum nt as acknowledged before rrle The fo oin instrument was acknowledged before me
this day of 201?by this do of s t - 20 L't ._by
41 tc r��r"!-f K-e-oL-- 73to.�ner
{Name of erson acknowledging) (Name of pc son acknowledging)
(Signature of Not Tc to of Florida) ignature Nota P lic-State of Florida)
Personally Kno OR Produced Identification Personal] K o OR Produced Idcntlflcationp''—
d At
[[INITIALS
of identity Type of id cation Pr c
CARLA J.COULTER ,"'n'�•
,•�;�"� '„;rte'. rSC A J.COULTER
mission Na, ;'' ' tdty PuLI(dieSl}to of Florida Commission o. Notary blic.state of Florida
My comm.Expires Oct 39,2017 aN,� , My Comm,Expires Oct 30,2917
71 d '
vised 07/1 0 4
IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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