HomeMy WebLinkAbout25 Lake Vista TrlALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4r cC I Permit Number:
S Hui g rermnt Anwication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort 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: 1 Q i
Legal Description: 1
Property Tax ID #: '� r'� -� Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: ___ Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Ait�ona worK to be er arme un er t Is permit — c ec a t t app y:
HVAC Gas Tank DGas Piping _ Shutters Windows/Doors
LJ Electric L 1 Plumbing ❑Sprinklers Generator E Roof Roof pitch
Tota! Sq. Ft of Construction:
Cost of Construction: $ ,
S Ft. of First Floor: _
Utilities: Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t:
Name: JOSEPH TULLY
Address:( ` { i.!
Company: GENESIS PLUMBING SERVICE INC
City:_; State:''
Zip Code:r' Fax:
Phone Na. �- 1
Address: 1532 SE VILLAGE GREEN DRIVE UNIT 8
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax: 772-335-2680
Phone No. 772-337-3682
E -Mail: w
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E -Mail: GENESISPLUMBINGSERVICES@GMAIL.COM
State or County License: CFC1429103
. -1 uLLJu6T as -?sauu or more, a KtcuK1JtL7 ivotice or commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
5t. 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 your Notice of Commencement.
mature of Owner/e Contractor as Agent for Owner gnature of Contract r/Licenses Dicder
STATE OF FLORIDA,, , STATE OF FLORIDA ;
COUNTY OF 4 _ �COUNTYOF - _ L o
The for Ding instru Qnt wPS acknowledged before me I The forgping instrument was acknowledged before me
thi day of -Z-*"' . 20 jy this`'f day of �I _ 20 Z by
77
(Name of person acknowledging) (Name of person acknowledging )
(Signa'turre" `fN(
Personally Know
Type of Identific
Commission No.
Revised 07/1
Public- State of Florida )
14
ure of Notary P6Mic-State of Florida )
P rSdLRWA EAAR k4IM Z Personally Known , ,,,�'� R Prq p etl�klllTcdl4k €Z
Commission # GG 97150 Type of IdentificaI commission # GG 97150
y C ommIss+on xpI re s
My CommissionExpire
Aprl 24 2021 '''•`',� Aprll 021
Commission No.
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