HomeMy WebLinkAboutbuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:��� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, t=ort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ' moi f r" ► ' -1-- - L `. '(14 C
Legal Description (
Property Tax ID #:- 'i" ` ` ° - ``� ��j �, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
A J ''[115 ial work to e er orme un er this permit— check a appy:
HVAC Gas Tank DGas Piping that
Windows/Doors
11 Electric I_J Plumbing Sprinklers ElGenerator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ t:s
S Ft. of First Floor: _
Utilities:Sewer OSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name: JOSEPH TULLY
Address: r^A�—�
Company: GENESIS PLUMBING SERVICE INC
City: Q C State �(,
Zip Cade: �r eq Fax:
Phone No. P�'`
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax: 772-335-2680
Phone No. 772-337-3682
E -Mail:
Fill in fee simple Title Hofer on next page 4 if different
from the Owner listed above)
E -Mail: GENESISPLUMBINGSERVICES@a EMAIL.COM
State or County License: CFC1429103
IT vaiue oT construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Afi1Hrace
State:
City: State:
Zip; Phone:
Not Applicable BONDING COMPANY: _Not Applicable
Name: _
Address:
City:_
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
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 with lender or an attorney before
commencing work or recording our Notice of Commencement.
5ig'riature of Ownef_ see Contractor as Agent for Owner -
STATE OF FLORIDA.
COUNTY OF `._+
The r oing instru ent vias acknowledged before me
this day of ("A = 20 -V 1bY
(Name of person acknowledging)
(Signatu-r Notary Pubrr- State of Florida)
y - ,Otis„rurr Pr�ek�tPF�eZ
Personal) Known , �.r
commission # GG 97154
Type of Identificati e l y ommisaion x it
�'=:'���°••' Aprl 24 2021
Commission No. rr'rrnna
Revised 07/15/2014
ature
STATE OF FLORIDA Ii
COUNTY OF
The forgoing instrument was acknowledged before me
this day of �e A ° 2D by
(Name of person acknowledging) �.
'{Sig ture of Notary _PA li'"ate of Florida )
Personally Known
Type of Identificati _ 0 "d commission # GG 97150
lyty Commission xpira
April 021
Commission No. 411 "11111'_
PLANS
REVIEWS FRONT ZNING� COUNTER 1 REVIEW � S REVIEWOR REVIEW
DATE
COMPLETE
INITIALS
VEGETATION I-SEATURTLE. � MANGROVE
REVIEW REVIEW REVIEW