HomeMy WebLinkAboutBuilding Permit Application 03/02/2017 6:35 PM FAX 7723372699 KENT—BLOSSER IM 0002/0003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTCO
Date:_T3��� rc ' Permit Number:
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 Residential xx
PERMIT APPLICATION FOR: Electrical
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Address:
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Address: 4612$unset Blvd,Ft Pierce,FI 34982
Legal Description: Indian River Estates r
Property Tax ID ti: 3402-608-0107-000-9 Lot No,6
Site Plan Name: Block No. 41
Project Name: Fred Skellonger
Setbacks Front Back: Right Side: Left Side:
Panel Change, Add Interlock Kit, Add Generator Receptacle.
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AdditionalworKtopel2ertormed und car thispermit—check a appy:
HVAC Gas Tank []G3$ Piping _Shutters Windows/Doors
EJElectric Plumbing ❑Sprinklers �-...I Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor: _
Cost of Construction:$ 1100.00 Utilities:cnSewerSeptic Building Height:
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NamerfedSkellenger Name: KontBlosaer
Address:Z2 Sunsot Blvd Company: Slosser Electric
City: Ft Pierce State: Fl Address: Port St Lucie
Zip Code: 34982 Fax: City: Part Sl Lucie State:Fl ---
Phone No.772.203-8333 Zip Code: 34985 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@gmail.com
from the Owner listed above) State or County LiCense: EC13001570
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
03/02/2017 6:36 PM FAX 7723372699 BENT—BLOSSER Z0003/0003
R NP-44
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WNGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City; City:
Zip: Phone: Zip: Phone:
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 ins�ectrpn. If you intend to obtain financing, consult with lender or an attorney before
commencing w&R orLAcordinA voyootice of Commencement.
10 S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA r
COUNTY OF � �-CIC C.C. COUNTY OF %-)f
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisqday of _ J 20 i Lby this day of flit h ,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida}
Personally Known I/ OR Produced Identification Personally Known OR Produced identification ..
Type of identification Produced Type of Identification Produced
Commission Norco m-) ,.,�•� Seal) LESLIE R.PHILLIP Com fission No, a7�J�' s ��"� (Seal)LESLIE R.PNILIJPS
Nottry PuMIC-Stat of RwIdt +Q ri Notary Public-Sttta 01 FIpr
Commlttlol�0 FF 21 823 Commission 4!EF!11
My Comm.Explrts Jul , 6 •,,� ' �, My Comm.Expires Jul 30,201
Revised 07/15/2014 ',g�,a�>~ BOndtOGlrOud+NiEiolalNorsyM '��.1�' Batttedxo„a, Natuy
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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