HomeMy WebLinkAboutPermit ApllicationAIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Darc' 512912020 permit Number:
Building Permit
Commercia I
Application
Plonning and Developntent Servtces
Building qnd Code Reqttlotrort Division Residentia I
2300 Virginio Avenue, Forl Pierce FL 34982
Phone: \772) 462-I)53 i:axr \772) 462-1,518
t nrn^I PERMIT APPLICATIoN FoR: EleCtfi
i P RO P oJ E ql rvryEq_v_E uINMIAIAT!
Address: 82 Mediterranean Blvd. Easl
property rax lD f':_11L:_lW:9161199 i Lot No
Site plan Nanrg; ST LUCIE GARDENS Block No.
Project Narne: V*gli11 n"t,{gf.e
DETAILED DESCRIPTION OF WORK:
Install 30amp Geirerator outlet and Interlock kit
New Electricai Meter Secr-,nd ilectrical Meter
LlglllrL9llle!INFORIVIATION:I
l
!
Additional worl< ro be perforrned under this permit - check all that apply:
_Mr:chanical *_ Gas l"rnl< _ Gas Prping _ Shutters _ Windows/Doors Pond
PitchEl ectri c -_ Plunroing _ Sprinklers _ Generator _ Roof
Total Sq. Fr of Constructicin:\n tsi nt Lrrcf Ll^nl
Cost of Constructior, 5 582 00 Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:
I ^ t-,,i.... A/^t -,rr -, Name Jal]lUe lvlULell.lr'l
Address.8l |ledrte, arre arl Blvd. East Company: Blosser Electric
: r'ir\/. Pofl St. l.ucie State l Address: POBox7305
, Zip Coae 34952 Fax: --
L-;.;:,-;;phone No /72-577-()064
city' lox St-!!!'e State: FL
ZiP Code: 34985 Fax:'-
i E-Mail: -- Phone ruo_I2-3j{ i955
i Fill in fee sinrple Titie Holder on next paCe ( if different
I from tfre Owner listed above)
E-Mai I nrblosser@gmail.conr
State or County License EC13001570
lf value oJ consrruction is 2500 of more, a RECORDED Notice of Commencement is required.
lf value of I-IAVC is 57,5iJ0 or more, a RECORDED Notice of Commencement is required.
CONTRACTOR:
Name: Kent Blosser
Address rAddress:
State:State:
FEE SIMPLE TITLE HOI.DER:
Name:
_ Not Applicable
Phone:
BONDING COMPANY:
Name:
Not Applicable
Address:Add ress:
City:----_
Zip:___ Phone:
owNER/ C0I\TRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated
I certify tl-r;t no worl< nr rnstallarion has conrmence'd prror to the issuarnce of a permit.
St. Lucie Loui,tV fi)ake> no represenraiion th.:t is granting a permit willauthorize the permit holder to build the subject structure
wtricfr is 'n cor/,icr witl' .rr'rv lpplrcable Home Owier: Asiociotion rules, bylaws or and covenants that may, restrict or prohibit such
siructuie Clelse consi'lt wirh'yorr Home Owners Association and review'your deed for any restrictions which may apply.
In consideration of the gf anting 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.
Tlre following building perrnit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, s',vimnring pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
improvenrents_tc your prlpertv. A Notice of Commencernent must be recorded in the public records of St.
Lucre Coun!y4nr1 ysasted/on the jobsite before the first inspection. lf y
with le AdCr or .rn att
-
----77 --=bef ore 11r e ncr ngwg4_o r reco rd i n
G;fiu,€ orlil,
STATE OT FI ORIDI\ -.coUNrY 0i:- -_---.-- )t. \ r.lUe- -
Sworn to {or :rfiirmecl} and subscribed before nre of
PhVsicat Presenc:e. or Onlinc-. Notarization
th' agL day of ___ fO"ftq -._, 2o2o by
{ent htt-*se-r
Nante of persirrr ntak,nP, 5i.rf ejnrlnt,
./
Personaily l(r,own . V - OR Produced ldentification
SignatLrre of Contractor/License Holder
STATE OF FLORIDA
couNrY oF 51. trrcrg
Sworn to (or affirmed) and subscribed before me of
Phvsical Presence or Online Notarization
tr" dq dav ot 0f\0\ -,2020 by
I
.a
Personally Known \/ OR Produced ldentification
Type of ldentification
P rod uced
*{ent fAtosrr
Name of person making statement,
(Signature of Notary
Commission No.
(Signature of I'Jotary
Commrssioil I'lo,
Type of ldet rtr'ication
P rod uce d
of FlorALd$ONMNS0|I I
MY CoMMTSS|oN # GG 970043 !
EXilEE$ ilarch 18, 2024
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IRECEIVI.D I ' I
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MY CoMM|SS|oN # Gc 970043
dfieR$: March 16,2024 i