HomeMy WebLinkAbout9044 Champions Way appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "� } i€ 4 Permit Number:
0 " t.
00-1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34-982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1
`
Legal Description: �� �_ t _ ; A1C. r��. C t
L
Property Tax ID #:..... `'_� � _. < . , , `,� -. 4 - C); ; l 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
t
CONSTRUCTION INFORMATION:
Additional workto e er orme un er t is permit — c ec a t apply:
Q
�HVAC Gas TankE]Gas Piping _ Shutters Windows/Doors
L_IElectric 121 PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft. of First Floor:
Height:
Cost of Construction: $ utilities: Sewer Septic Building
OWNERAESSEE. CONTRACTOR:
1i i
Name , 1 i { ` a' Name: JOSEPH F TULLY
Address: - Company: GENESIS PLUMBING SERVICES INC
City. �I_ ��_3' State:- Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
Zip Code: "77- "�I . Fax: City: PORT ST LUCIE State: FL
" 34952 Fax: 772-335-26&()
Phone No. r? - Zip Code:
E -Mail: Phone No. 772-337-3682
Fill in fee simple Title Folder on next page: ( if different E -Mail: genesisplumbingservices@gmaiLcom
from the Owner listed above) State or County License: CFC1429103
If value of construction is $2500 or more, a RECORDED Notice ov LOMmencement is requireu.
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:
Add ress:
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 praying 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 C7wneGf- see/Contractor as Agent for Owner gnature of Contra ctdr/license Ider
STATE OF FLORIDA., STATE OF FLORIDA
COUNTY OF - ° �_� COUNTY OF
The for iRg inr ent was acknowledged, kefore me The forgoing instrument was acknowledged before me
this day of -i L , 20 �by this1;��IaNy ofl � f d� 20 by
(Name of person acknowledging } {Name of person acknowledging j
i �1
ILI
(Sign atufi= of_Notary Public- State of Florida)'
Personally Known 7
Type of Identificati I i Commission # GG 37150
A <,3 y ammissEon xpires
Apr! 2d 2Q21
Commission No.
Revised 07/15/2014
(Signature of Notary Public- State of Florida a
Personally Known R Pr A90LeJANred 2 I
,',.
Type of Identificati°o commission # GG 97150 i
aR
=
my Commission Expires
April 021 it
Commission NO.
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