HomeMy WebLinkAboutBuilding Permit Application 07/02/2015 10:58AM FAX 7723372699 RENT—BLOSSER R0002/0003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; Permit Number: - 6 ZJ�
Building Permit Application
Plonnin9 and Developinent Services
Building and Code Regulation Division
2300 vlrginio Avenue, Fort Pierce FL 34952
Phone: (772)452-1553 t=ax: (772)4G2-1575 Commercial x Residential
PERMIT APPLICATION FOR: Electrical M
o ,
Address: 10980 S Ocean Drive, Jensen Beach, F134957
Legal Description:
Property Tax ID 9: 4512-702-0000-000-9 Lot No.
Site Plan Name: Oean Dunes Condominium Block No.
Project Name: Ocean Dunes Transfer Switch
Setbacks Front Back: Right Side: Left Side:
4 WIN
sw �. r f e• Bar rp;�
Replacement of transfer switch.
6- 111ional
work to er orme under is perms -•check a "Shutters
HVAC [:Gas Tank ❑Gas Piping _ Q Windows/Doors
Electric D Plumbing ❑Sprinklers �Generator �Roof
Total Sq. Ft of Construction: So. Ft. of First Floor:
Cost of Construction: $ Q?, ,(, Utilities; Sewer ESeptic Building Height:
gf
NameQpli Jensen Fee LLC Name; Kent Blosser
Address.,140 E 45th St FL 34 Company: Blosser Electric
City: New York State:NY Address; PO Sox 7305
Zip Code: 10017 Fax:772-229-2244 City: Port St Lucie _State:FL
Phone No, Zip Cotte: 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: nrblosseragmall.com
from the Owner listed above) State or County License; EC13001570 --.�
If value of construction Is$2500 or more,a RECORDED l iee of Commencement is required.
07/02/2015 10:58AM FAX 7723372699 RENT-JBLOSSER 20003/0003
DESIGNER/ENGINEER: _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:
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
WARNIotinsp'ctiorl.
R: Your failure to Record a Notice of Commencement may result'n your paying twice for
improver property. A Notice of Commencement must be recorded a posted on the jobsite
before tIf you intend to obtain financing, consult with lender an attor y before
common recordln r Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .3T L-LACA& COUNTY OF a J=Lj '.n•
The forgoing instrument was acknowledged before me The forgoing instrum•nt was acknowledged before me
this RzcklayoF 20/ by thi5a+tddayof 20 by
(Name of Pers- �Ike(ging,) C '� (Name of person acknowledging J
CC��''
(Signature of Notary Public-Stateof Florida J (Signature of Notary Public-State of Florida)
Personally Known w oR Produced Identification Personally Known �!�OR Produced identification
Type of Identification Pro IC
pe of identification Produced
r �AVITR!M.GARClA t � IrRI M.GARCIACgmmission No. '` GN ablie-5tatc of Floridammission No. 6
�� My Comm.>xplras Apr 1,2016 -': : : Notary Pc tic-State of Florida
00 F% _ Commission# EE 165187 My Comm.Expires Apr 1,2016
11evised 07/15/2014
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