HomeMy WebLinkAboutBuilding Permit Application Jan 23 18, 12:42p Genesis Plumbing 7723352680 p.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ l I �' Permit Number:
6uilding Permit Application RECEIVED
Pianning and Development ServicesJqN J
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 S? Lucie County, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re entiat -
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION::
Address:
Legal Description'��-�F
Property Tax ID#: G Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAELED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit—check all that appy:
HVAC Gas Tank E]Gas Piping Shutters E]Windows/Doors
_
UElectric LJ Plumbing ❑Sprinklers Generator LJ Roof Roof pitch
Total Sq. Ft of Construction: S Ft,of First Floor:
Cost of Construction: $ Utilities: 0Sewer QSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: JOSEPH TULLY
Address:C�� L ` L;`!�'�?- ;�;_� Pf2jy'0Company: GENESIS PLUMBING SERVICE INC
City:
'ieI-� State:
— Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
�,-�' -�,�%fit . h
Zip Code: Fax: City: PORT ST LUCIE State:EL
Phone No. 5 1 4\1 ! A 0—: _711 Zip Code: 34952 Fax: 772-335-2680
E-Mail:_- Phone No. 772-337-3682
Fill in fee simple Title Holder on next page(if different E-Mail: GENESISPLUMBINGSERVICES@GMAIL.CCM
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.
Jan 23 18, 12:42p Genesis Plumbing 7723352680 p.2
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 County makes no representation that is granting a permit will authorize thepermit 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.
Signature of Owned see/Contractor as Agent for Owner ._ ignature of Contract r/Licenses 61der
STATE OF FLORIDA, , STATE OF FLORIDA
COUNTY OF } 'l- 1. 't COUNTY OF ..
The fo[going instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this, day of j r;;'� 20 Ljt_Uy this,_ day of r) i_;.-�`� 20 by
(Name of person acknowledging) (Name of person acknowledging)
i
(Signature-6f Notary Publfo-State of Florida ) '(Signature of Notary Public-State of Florida}r
Z Personale Known Pr
Personally Known `N..•�• 3fj Pr�dteNtPfFC�iGt Y ""�'�J dpEletYtNkAtMZ
Type of Identificati =� Commission a GG 97t 50 Type of Identificati d Commission#GG 9715
y ommission txplre
1:'+«� '' cy t My Cammiss�on xpir
Commission No. "'��«z Aprl 24 2021 �,?�a�a,,',r Aprll 021
Commission No. n, ,,.,
Revised 07/15/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i
COMPLETE
INITIALS