HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/14/2020 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOC TION:
Address: 1536 NW Buttonbush Cir
Property Tax ID #: 4426-815-0057-000-6
Site Plan Name:
Project Name: Salamy Residence
DETAILED DESCRIPTION OF WORK:
Add (3) new low voltage landscape pathway lights.
Install timer for exterior fountain located in front entry.
Install wire, conduit, and new receptacle for exterior fountain.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION1
Residential X
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 2,384
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Virginia Salamy
Name: Kent Blosser
Address:1536 NW Buttonbush Cir
Company: Blosser Electric
City: Palm City State: _
Zip Code: 34990 Fax:
Phone No.614-579-3293
Address: PO Box 7305
City: Port Saint Lucie State: FL
Zip Code: 34985 Fax:
Phone No772-337-0055
E-Mail:ginsal@me.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail electricinc.info@gmail.com
State or County License EC13001570
IT value of construction is 25UU or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —No t 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 OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvemen to your property. A Notice of Commencement must be recorded in the records St.
public of
Lucie Cou nd posted on the jobsite before the first inspection. If you ' nd to obtain financing, consult
with le er an attorne before commencing work or record of Commencement.
ZingouAroYce
Signature f Contrac or/Lice se Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
STATE OF FLORI�PA
COUNTY OF it
Swq/n to (or affirmed) and subscribed before me of
1V
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of Dzeff E _, 2020 by
Physical Presence or Online Notarization
this tLI day of ecem 2020 by
iom� \ \� v�
4f n `1 I ( J1s::�Pv/
Name of person making statement.
Name of person making tatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ALISON HANSON .b —]
(Signature of Notary Pub :"� td€Floepjrtj S:Marchle,202a 1 i
(Signature of Notary Publi a o .( IdlidM)AMISSION#GG970043
N EXPIRES: March 16, 2024
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