HomeMy WebLinkAbout360 Ashley WH permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i ki l c j Permit Number:
s
ounuing Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4.62-1553 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:
Legal Des
Property Tax ID #: —yar5 1 ,i Lot Na. i
°-
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Bight Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CIL �;v Of "ar-e- r
CONSTRUCTION INFORMATION:
Ad J i t i o n a wear to e er orme un er t is permit — c el
a appy:
El 11 Gas Tank Gas Piping
Shutters Windows/Doors
Electric Z Plumbing Sprinklers
11 Generator Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of Frst Floor:
Cost of Construction: $ Utilities: —SewerSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name iA Q1t I
Name: JOSEPH TULLY
Address;
Com an GENESIS PLUMBING SERVICE INC
p y:
_
City:State:
Add1532 SE VILLAGE GREEN DRIVE UNIT B
ress:
Zip Code: Fax:
City: PORT ST LUCIE State: FL
Phone No., f� rQ
Zip Code: 34952 Fax: 772-335-2680
E -Mail:
Phone No. 772-337-3682
Fill in fee simple Title Raider can next page (if different
E -Mail: GENESISPL IJMBINGSERViCES@GMAIL.COM
from the Owner listed above)
State or County License: CFC1429103
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;
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 count yy 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 wil€, 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 your Notice of Commencement.
r-
Signature of Owner..( see/Contractor as Agent for Owner ignature of Contra ctdr/License Flolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �- COUNTY OF -
The forgoing instrument was acknowledged before me
this I � day of N " %&._ 20 i'7by
(Name of person acknowledging)
t
,v t
(Signature of Notary Pub€ic- State of Florida
Person@Ily Known .,.'�R,'Pr Pr �BhPtPIFc € FZ
Type of Ideniificati Commission # GG 97190
-y cM1 y Commission Expiri
Apri),2,4 2021
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this I day of iib' _ 20 l di by
(Name of person acknowledging)
_ (Signature of Notary Public- Siate of Floriday)
Perso'a"" Known ". R Pr �lq�te)rtlfl a x
Type of Identificati �°o `fid commission # GG 97160
= _
My Commission Expires
Commission No. �'%�;,;'�'' April 021
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