HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/22/19 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 STPhone: (772)462-1553 Fax: (772)462-1578 Commercial X Reside
PERMIT TYPE: Electrical
PROPOSED IN'PROVEMENT ,L`OCATION
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Address: 1809 Totten Rd.
Property Tax ID#: 2417-323-0004-000-6 Lot No.
Site Plan Name: Block No.
Project Name: 18-2307
DETAILED DESCRIPTION OF WORK
New electrical 400 amp service.
CONSTRUCTIONFORMATION
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Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
00Cost of Construction: $ 2- 000, Utilities: _Sewer _Septic Building Height:
OWNER iLESSEE &f TCON
RAC R
Name Mastec Inc Name:Kent Blosser
Address: 7221 East Drive Martin Luther King Jr. Blvd. Company: Blosser Electric
City: Tampa State:_ej Address:PO Box 7305
Zip Code: 33619 Fax: City: Port St. Lucie State:Fl
Phone No. 813-235-4925 Zip Code: 34985 Fax:
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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPL'EMENTAI. CONSTRUCTION.LIEN LAW INFOR(1%IATI01 j5
DESIGNER/ENGINEER: p _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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 OWNE : Y ur failure to Record a Notice of Commencement may result in your paying twice for
improvements. roperty. A Notice of Commencement must be re ded and posted on the jobsite
before the fir t inspe Ion. If you inteto obtain financing, consult wi nder or an a rney before
commenci wor r recordin o otice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
J COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2_7,day of 2019� by this_V— day of ;PcYN 20_n by
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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nature of Notary P ofCFoGG 68535 (Signature of Notar PublicState of Florida
My Commission Expires quluq, LAUR H LLER
Commission No. ��� ,.`o�ar"o%'�� ISP
a— Fe�rky 01,2021 Commission No. ommissi G 68535
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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