HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-IS53 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropdox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: )_��E her"Pj";, 'a�(��I"T
Legal Description: ° , =�{' , E i ' ,` • •-.} ( l . .
Property Tax ID #: r =, `-� 1 t`^-; - -- Lot No.
Site Plan Name: Black No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
_ �t t -ter -C
CONSTRUCTION INFORMATION:
Additional work toepej r orme un ei t �s pelmet - c ec a t appy:
HVAC F Gas Tank ❑Gas Piping Shutters Windows/Doors
1J Electric L^J Plumbing oSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer F Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name - �� 1( f '`
Name: JOSEPH F TULLY
_
Address: �" } r "�t�
Company: GENESIS PLUMBING SERVICES INC
. r.' b
City: \ til. 3 �:. �;� i `-, ',. , State: k
Zip Code: l -:' � i t Fax:
Phone No. 1'x-1 ct Li -I -- 914
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
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-MaII: genesisplumbingservices@gmaii.com
III
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:
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.
iature of Owner/ see-fContractor as Agent for Owner gnature of Contract r/Li��ldf e�
STATE OF FLORIDA`, STATE OF FLORIDA c
COUNTY OF _._`} }- COUNTY OF _ Lu 10�--
The forgoing instrument was acknowled ed efore me The forgoing instrument was acknowledged efore me
this day of 20 aby this , day of. 20 1 by
-(,1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- Stalte of Florida)
Personally Known 4��*`: Pr�ilahPtPftz
Type of Identificati r Commission # GG 97150
_�, [�X y ommiss+on xp1ras
`� Aprl a4 2021
Commission NO. ''4rrrrn+�4
Revised 07/15/2014
-(Signature of Notary Public -Mate of Florida) "
Personally Known ,","',",,RPrcB*"AggletAlti-cdaRfZ
Type of Iden ti commission # GG 97150
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J o` My Commissson xpE -
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
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MANGROVE
COUNTER
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DATE
COMPLETE
INITIALS