HomeMy WebLinkAboutBuilding Permit Application 01/07/2016 2:04 PM FAX 7723372699 KENT–BLOSSER 00002/0003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AG Permit Number:
." � RECEIVED JAN 0 7 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fon Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial XX Residential
PERMIT APPLICATION FOR: Electrical i
Address: 10980 S Ocean Dr, Jensen BEach, FI $4957
Legal Description:
Property Tax ID#: 4512-702-0000-00019 Lot No.
Site Plan Name: Block No.
Project Name,
Setbacks Front Back: Right Side: Left Side:
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AC[CiltiOnal wor toer orme un er t is permit–check a appy:
❑HVAC �GasTank ❑Gas Piping _Shutters []Windows/Doors
ZElectric F-1Plumbing ❑Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: _ SFt.of First Floor: _
Cost of Construction:5—�00 -0�_ Utilities: Sewer Septic Building Height:
AM
000,
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Name Ocean Dunes Cando Association Name: Kent Blosser
Address:10980 S Ocean Dr Company: Blosser Electric
City: Jensen Beach State: FL Address: FO Box 7305
Zip Code: 34957 Fax: City: Port St Lucie State:Fl
Phone No.772-229-2244 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: nrblossera@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.
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01/07/2016 2:04 PM FAX 7723372699 KENT—BLOSSER Z0003/0003
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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: _Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: Address.-
City:
ddress:City: — City,
Zip: Phone: zip: Phone:
1 certify that no work or installation has commented prior to the issuance of a permit.
St.Lucie Count 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: r failure to Record a Notice of Commencement may result in your paying twice for
improvements to you perty.A Notice of Commencement must be recor and posted on the jobsite
before the first ins on. If you intend to obtain financing, consult wit er or an attorney before
commencin w recordin ur tice of Commencement.
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA / . , STATE OF FLORIDA
COUNTY OF '61 /GfC� COUNTY OF q,
The for oing instru ent was acknowledged before me The for oing instrument was acknowledged before me
this day of 20/�by this A day of &ey—YI UA .20 /S by
(Name of person acknowledging) (Name of person acknowledging)
V"AL
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prd c I 11 t n Personally Known OR Produced Identification__.
Type of Identification Pr uCq Type of Identificati
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Commission No. �' �" C45M& 0 FF 217823 Commission No. _�•
pM.ir.Cad mE�xpyY,n�J�4 330..,2019
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS