HomeMy WebLinkAboutBuilding Permit Application 01/05/2016 8:29 AM FAX 7723372699 KENT—BLOSSER IM0002/0003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s Permit Number: i "dd35
RECEIV^p ,API 042016
Building Permit Application RECEI''-,) JA^J 05 2016
Planning and Development Services
Building and Code Regulation.Division
2300 Vlrginfa Avenue,fort Pierce FL 34982
Phone: (772)462-•1553 Fax; (772)462-1578 Commercial � Residential XX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line' '-'�� dl
Address: 7651 Pelican Point Dr. Jensen Beach, FI 34957
Legal Description: pelican Point West
Property Tax ID#: 3522-7,00-0005-000-6 Lot No,
Site Plan Name: Block No.
Project Name: Bernstein Residence
Setbacks Front Back: Right Side: Left Side:
1
Temporary power pale. This will be removed when residential home completed.
ACiditional work to be nerformeounder this permit—check all t appy:
❑HVAC Gas Tank 7Gas Piping _Shutters Windows/Doors
RElectric 0 Plumbing Sprinklers El Generator Roof
Total Sq. Ft of Construction: 5Ft.of First Floor:
Cost of Construction:$ 500.00 Utilities:ctSewer Elseptic Building Height:
Name Fredic Bernstein Name; Kent Slosser
Address:PO Box 415Company: Blosser Electric
City: Stuart State: FL Address: PO Box 7305
Zip Code: 34995 Fax: City: Port St Lucie State:Fl
Phone No.772-675-3144 Zip Code: 34988 Fax: 772-337-2699
E-Mail:islandvillage@bellsouth.net 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: EC13001570
if value of construction is$2500 or more,a RECORDED Notice of commencement is required.
01/05/2016 8:29 AM FAX 7723372699 KENT—BLOSSER 1910003/0003
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip; Phone:
FEE SIMPLE TiTLE HOLDER: T 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,swim=000ls,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNQ_ failure to Record a Notice of Commencement may result in your paying twice for
improvements to ur p operty. A Notice of Commencement must be recorded and posted on the jobsite
before the first ' spe an. If y tend to obtain financing, consul lender or an attorney before
commencin ork reca d' our Notice of Commencement. it
5
51ature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Vu'l&—e,
The for oing instru ent was acknowledged before me The forgoing Instr ent was acknowledged before me
this-7 day of 201ly by this IL day of 20 1�p_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-state of Florida)
Personally Known V-11"OR Produced Identification_.. Personally Known OR Produced identification
Type of identificF20
Type of identification Produced
LESLIE R.PHILLIPSCommission No- i •�'= Notary Pub4se to Of FIOiIda Com ss 't11� flu aCommiss(on+v FF 217823 �.aN cc Pupflt_gyp a Fjoriftn'rPa Jul 30,20111 • CO' y W COm�•Expires Jul 90,2019Revised 07/14 w ,~ fhaiphNenonMr>fafxfyJmL
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS