HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I um�
Building Permit Application
Planning and Developmen t Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1.578
Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
L✓ P s J
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Acilrtiona wor c to e er orme un er t is permit — c ec a
HVAC Gas Tank E]Gas Piping
L_J Electric Q Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $�
n apply;
Shutters Windows/Doors
DGenerator Roof Roof pitch
5 Ft, of First�Fl�Djar: _
Utilities: �Sewer l_JSeptic
Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 5f~1 i f 4 Name; JOSEPH TULLY
Address: Company: GENESIS PLUMBING SERVICE INC
City;3
—State: i,.. 1532 SE VILLAGE GREEN DRIVE UNIT B
_ Address:
Zip Code:Fax: City: PORT ST LUCIE State:FL
Phone No. ` �' 1 '': Zip Code: 34952 Fax: 772-335-2680
E -Mail: 0"-) ; �. Phone No. 772-337-3682
Fill in fee simple Title Holder on next page ( if different E -Mail: GENES ISPLUMBINGSERVICESaa 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 LAVH INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Prone:
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 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 pians, the Florida Building Codes and St. Lucie County Amendments.
The foliowing 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.
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Signature of Own erA see%Contractor as Agent for Owner -:.. 7Wnature of Contractor/License alder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me
this' day of zfl I'_ Lb}T
(Name of person acknowledging) `
(Signature ofi Notary Publ'i'c- State of Florida)
_' OtNINPq Z
Personally KnownPr
Type of Identificati X Commission # GG 97150
o,g y Commission txpires
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this, r !� day of ` : ` (_ 20 jLL by
(Name of person acknowledging j
- (Signature of Notary Public- State of Florida }
Personally Known - ,•""'"� Prg3;dgeJ�dTeZ
Type ofdentl ati + o Commission # GG 97150
�y t: My cOmm15SiUr1 xpsres
it
Commission No. April 021
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