HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:' Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3498,1
Rhone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR: To Select from drapbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Q t -,10-1 (-r –, ,
Legal Description:
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Property Tax ID#:j�`-j
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
`I 0f
( I r, I?
Lot No.
Block No.
CONSTRUCTION INFORMATION:
A itiona wor to e er Dime un er t is permit– c ec a t t app y:
❑HVAC Gas Tank El Piping —Shutters ❑ Windows Doors
Electric L"J Plumbing ❑Sprinklers ❑ Generator ❑ Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
SFt. of First f=loor: _
Lltilitiesl]Sewer ❑Septic
OWNER/LESSEE:
Name
Address:
C)I U. E C_
City: '
Tom'
tr e �, t - i �'_Mate: .
Zip Code:
7
Phone No.
7:;-
E-Mail:
E-Mail:
Fill in fee simple Title Halder on next page ( if different
from the Owner listed above)
Building Height;
CONTRACTOR: -
Name. JOSEPH TULLY
Company: GENESIS PLUMBING SERVICE INC
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: GEN ESISPLUMSINGSERVICES@GMAIL-COM
State or County License: CFC1429103
If Value of construction is $25Q0 or more, a RECORDED No#ice 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 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.
Signature of Owner) see iContractor as Agent for Owner ignature of Contractor/License lo`Ider
TATE OF FLORIDA,,,STATE OF FLORIDA � ,y < F Y, �
COUNTY OF
COUNTY OF
�.
The forgoing instrument was acknowledged before me
this�t, day of = 20 Eby
(Name of person acknowledging)
(signature of Notary Public- State of Florida) " f'
Personally Known ",.•�:a�"%j Pr&�lektFfFtZ
Type of Identificati - Commission # GG 97150
de y ommission x p I r
�4 1
Commission No. �`,«`• Apr► 24 2021
Revised 07/1512014
The forgoing instrument was acknowledged before me
this , , day of A d f,_ a , 24 1. S by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida } ``
Personally K Prq%J=AW9LeJANiealtQRf Z i
Type of Identific t IV+° d Commission # GG 97150
=* -
�,y o+= h/iy Commission xpires i
Commission No. "'%°'';,°' April 021
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