HomeMy WebLinkAboutBuilding Permit Application 10/08/2015 3:39 PM FAX 7723372699 KENT–BLOSSER Z0002/0003
ALL APPLICABLE INFO IVIUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 15 Permit Number; \5kc) _014
RECEIVED OCT 0 9 M
Building Permit Application
Planning and Development Services
Building and Code Regulationi Division
2300 Virginia Avenue,Fort Pierce FL.3082 Residential XX
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATIONJ FOR: Electrical
Address: 322 Shady Lane Port St Lucie, F1 34952
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Legal Description. River Park-Unit 2-SLK 12 S 112 of Lot 6 and all of Lot 7
Property Tax ID#:,3419-510 10079-000-5 Lot No.Unit 2
1 —
Site Plan Name: Ramirez Re�idence Block No. 12
Project Name: 322 Shady Lane
Setbacks Front Back: Right Side. Left Side-
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Move existing service rvieter/riser to rear corner of house.
t ona war o ormea under I all apply:
Mt
this permit-
F�p F1
HVAC Gas Tank G ars Piping 1 n'g —Shutters o Windows/Doors
Electric o Pluirnbing OSprinklers F ]Generator Roof
Total Sq. Ft of Construction: Sa. Ft.of First Floor:
Cast of Construction:$ 1700100 utilities:r7 Sewer Septic Building Height:
Name Berta Ramirez Name: Kent Blosser
Address:322 Shady Lane Company: Blosser Electric
City: Port St Lucie State: FI Address: PO Box 7306
Zip Code: 34952 Fax: City: Port St Lucie State:Fl
Phone No.772-398-8268 Zip Code: 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: nrblosser@gmail.com
from the Owner listed above) State or County License- ECI 3001570
If value of—construction is$2500 or more,a RECORDED Notice of Commencement Is required.
10/08/2015 3:39 PM FAX 7723372699 KENT—BLOSSER U0003/0003
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I State: City: Stater
Zip: Phone:) Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I 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 Assoction 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 approvI d 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing,consult wit r or an attorney before
commend k or recordin our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo oing Instrument was Icknowledged�fore me The forgoing instrument w s acknowledged before me
this .day of Oc.�"o�i� 20 �by this-S!day of 0C-kve I ,20 IT, by
(Name of persona owledgirlg) (Name of person acknowledging)
( a of Notary Public-State of Florida) / (SI ure of Notary Public-State of Florida)
Siersonally Known OR Produced identification y ersonally Known_OR Pr duced Identification
Type of Identification Produced ��1' �(?b b i I"137o. Type of identification Produced_�L_ ��6 b.L
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commission No.`r- 16(/II� `•hN� "� (Seal)FRANCESCOMASUTTI Co mission No.FF) 7 „w�,,
+ a +�" FRANCE5C0 MASOTTt
4s Notary Public-State of Flo lda i
-•: _ : �4. Notar Public-State of Florida
my 60111111:Expires-:, • a •' T My Comm.Expfres Nov 6,2018
Revised 07/15/2014 Commissloo k FF 164117 :,.
' `•" .^,�.rCommission N FF 164 17
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