HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f 1� Permit Number:
Building Permit Application
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:
Legal Description: k`l-.k-VD� �� x r "C - --9.21
Property Tax ID #: - C3 — t;)--- Q Lot No_ 'I
Site Plan Name: Black No. � U
Project Name:
Setbacks Front Back: Right Side: Left Side -
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
A itiona wor to e erformea under this permit : c ec
HVAC Gas Tank ❑Gas Piping
L�IElectric ®Plumbing OSprinklers
a appy:
` Shutters Windows/Doors
[lRoof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ tu., Utilities: _ Sewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
NameJOSEPH'�`° ;' i •.i.
Name: JOSEPHTULLY
Address: 0 5 - Cy'\ 1 `, L-
city:f tM C (7 State:
Company; GENESIS PLUMBING SERVICE INC
Address: 1532 SE: VILLAGE GREEN DRIVE UNIT B
Zip Co d e: '�5L4 11 •� Fax:
City: PORT ST LUGIE State: FL
Phone No. - zf
Zip Code: 34952 Fax: 772-335-2680
E -Mail:
Phone No. 772-337-3682
Fill in fee simple Title Holder an next page if different
E -Mail: GENESISPLUMBINGSERVICES@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
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.
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
comMe ncin work or recording your Notice of Commencement.
_2�
Signature of Owner, see Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � 3 _ COUNTY OF � --'sem'® ,
The fp o'ng instrur,�ent uuas acknowledgeti before me The 2dayof
ing instrument was acknowledged before me
this of 1�`�_�;_ ', - 2D 9by this, +.a :-� k 20 by
(Name of person acknowledging) (Name of person acknowledging)
{Signature -of Notary Public- State of Florida)
..,= �puorrrr
Personally Known a�,F�j PrRE�Jek�tl!F�€Z
Type of Identificati Commission # GG 97150
Y ommissian Expi
Commission No.
; Apri 24 2021
Revised 07/15/2014
(Signature of Notary Public- State of Florida)
Personali Known °""r= Pr
y .,1� qAqdetARiEdiG3.nZ 1.
Type of Identificati _°o Commission # GG 97150
e, o My Commission xpires
Commission No. ~""n°;;Q� April021
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