HomeMy WebLinkAbout8912 Champions Way appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � i Permit Number:
194, J, ii
Building Permit Application
Planning and Development Services
Building and Code Regulotion 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 lime
PROPOSED IMPROVEMENT LOCATION:
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Address: Ca C f L�j e L
Legal Description:-, V l i` QQ e � L
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Property Tax ID #: r) --
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CONSTRUCTION INFORMATION,
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Name I.�� _t� "k i CICi i' i
Name: JOSEPH FTULLY
Additional work to be erformed under
�HVAC Gas Tank
t ispermit --c-Feck
[]Gas Piping
all
that apply: �—
Shutters
Windows/Doors
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: genesisplumbingservices@gmail.com
_
Electric Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
SgFt.j of First Floor:
Cost of Construction: $
4.mm_ Utilities: [ _[Sewer
Septic
Building Height:
OWNEI+R/LESSEE:
CONTRACTOR:
Name I.�� _t� "k i CICi i' i
Name: JOSEPH FTULLY
Addres : C7�'C4 IQ C I° cam ti Gr—Is V "; ;'
Company: GENESIS PLUMBING SERVICES INC
City. - y ��C� 9 State: � �.
Zip Code; r! W" Fax:
Phone No. \ I 93 V4
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:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: genesisplumbingservices@gmail.com
State or County License: CFC1429103
It value of construction is $2500 or more, a RECORDED Notice 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 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 your Notice of Commencement.
Signature of Ownerj'-Le �se4jtontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ='
The forgr instrument was acknowledged, before me
this day of � 20 ` by
{Name of person acknowledging)
(Signature df Notary Public, State of Florida
Personally Known 3 PrZ
?Jar r
Type of Identificati r commission # GG 97150
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♦�pr� 4Y d.WF
9lf OS M1�94 �;:
Commission No. '""""`"
Revised 07/1512011
ature of Cont
STATE OF FLORIDA
COUNTY OF
The 20 1.3 forgoing instrument was acknowledged_ before me
_ f,
this 'Z�_ day of � i � by
(Name of person acknowledging }
(Siknature of Notary Public -,5 ate of Florida }
Personally known Pr%*AT,490ieJANTed fZ
Type of Identificati } _, "d commission # GG 9715
My Commission Wres
Commission No. �°'"+ April(alt
REVIEWS COUNTER I REVIEW I S REVIEWOR REV EW
DATE
COMPLETE
INITIALS
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW