HomeMy WebLinkAboutPermit ApplicationAIIAPPTICABLE INFC) IVIUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
Building Permit Application
P lo n n i ng a nd Deve lo gt m e nt Serv ice s
Building ond Code Regutation Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phone; (772) 462-1553 Fax (772\ 462-L57B Commercial Residentia I
PERMIT TYPE: ElectriCal
Property Tax lD #: 3402-609-0044-000-2 Lot No 31t32
Site Plan Name:Block No. 23
Project Namc: l-ucas Re;siocnce
DETAILED DESCRIP-IION OF WORK:
Electrical wiring for kitchen remodel.
CONls-rnu-CfnfV rftf fOnf,rf nftOfrf ,
Additional work to be performed under this permit - check all that apply:
_Mechanical _.- Gas Tank _ Gas Piping Shutters _ Windows/Doors
_ Roof Pitch_ Electric _ Plumbing _ Sprinklers _ Generator
Sq. Ft. of First Floor:Total Sq. Ft of Construction:
Cost of Construction 5 :l'250.00 Utilities: _ Sewer _- Septic Building Height:
OWNER/LESSEE:
Name: Kent Blosser
Add ress:Company: Blosser Electric
City: --State:Address:P.O.Box 7305
Zip Code:Fax:1^;1,,. Port St Lucie
-''t'State: FL
Phone No.Zip Codc: 3499s
phone No 772-337-0055
Fill in fee simple Title tlolder on next page ( if different I E-Vuit nrblosser@)gmail.com
from the Owner listr:d above)State or Countv License EC13001570
PROPOSED I M PF:O'/EM ENT LOCATION :
Address: 5413 Seagrape Dr.
lf value of HVAC is $7,500 or more, a RECORDED Notice of Commencemcnt is reouired.
SU PPLEM ENTAL CONSTRUCTION
DESIGNER/ENGINI
Name:
LIFN.LAW,,t CIRMAT|ON,:
Not Applicable MORTGAGE COMPANY:
Name:
Not Applicable
Address:Add ress:
City:
FEE SIMPLE TITLE
Name:
State:
Ph one
H()LDER:Not Applicable
Phone;
BONDING COMPANY:
Name:
City:State:
Not Applicable
Address:Add ress:
City:_-__-City:
Phone:
OWNER/ CONTRACT()R AFFIDVIT: Applicatlon is hereby madc to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced pri<-lr to the lssuance of a permit.
St. Lucie County makcs nc representation that is granting a permit will airthorize the permit holder to build the subiect structurewhich is in contlict witfr any applicable Home Owners Association rules, bvlaws or and covenants that mav restrict or prohibit suchstructure. Please consult rvith your Home Owners Association and review'your deed for any restrictions r,rihich may apply.
ln 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 approverd 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, surinrming pools, fence's, walls, signs, screen rooms and accessory uses to another non-residential use
"}YARNING TO O}YNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMP S TO YOUR PROPERTY. A NOTICE OF C MUST BE RECORDED AND
POSTED ON SITE BEFORE THE FIRST INSPECTION. IF YOU TO OBTAIN FTNANC|NG, CONSULT
}YITH Y OR AN BEFORE RECORDINC
dtu of Owner/ l.essee/Contractor as Agent for Owner
STATE OF FLORID,A
iour,rrv oF ' S+. Lv"le
Signature of Contractor/License Holder
STATE OF FLORIDA
coUNTY oF Sr{' L*lu
The forqoing instrument was acknowledged before mer
tr"i" r({h ..r-L ^r tl ^,: \ rn" lQ r.,zo lt by
Ihe forgoing instrumenl was acknowledeed before me
thrs lllf oay ot _ler{___, zo_]1 bv
K*,,* Bto ssur Ke^t Blosser
Name of person making statement.
,/',' \/l)crsonallV Known -.._-" -. _ OR Produccd
Type of ldentification
P rod uced
Commission No.
REVIEWS f-RoNT
COIJNTER
DATE
RECEIVED
DATE
COMPLETED
ldentif ication
Name of person making statement.
./
Personally Known z
. _ OR Produced ldentification
T'rnn nf lr"lanf ifin:tinn
Prod uced .
h, rr tbJ'
(Signaturc of Notary Public- State of Florida )
Commission No.(Sea l)
b'r-W*(aisn;iu6;i-N;G;ipur
EV,
ZONING
REVIEW
SU PERVISOR
REVIEW
GUY R BOUCHER
i uv comutsstoN # GcogtSloGUY R BOUCHER
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