HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' r j Permit Number:
Building Permit Application
Planning and Development; Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982
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: ' 'i ¢j r ! ; , LL
Legal Description. .tp:' j`�Cr �t�ri Oma- � _`' L_i4 _` i'
tot No.
Property Tax ID
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional worK to f1r orme un er t is permit- c !1A
a at app y:
OHVAC Gas Tank Gas Piping
_Shutters Windows/Doors
Roof
Electric Q Plumbing ElSprinkiers
Generator Roof pitch
Total Sq. Ft of Construction:
'Sq, Ft. of First Floor:
0 Height:
Cost of Construction: $ ��; ' , i i + Utilities:
Sewer Septic Building
OWNER/LESSEE:
CONTRACTOR:
r� , ? ,, :�,
Name ���t� �;
Name: JOSEPH F TULLY
Address c` ?� " C..�, ; �;>d.
Company: GENESIS PLUMBING SERVICES INC
`J�
Cita: --y _ ��' (� State:
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
ki
Zip Code: Fax:
City: PART ST LUGIE State: FL
'.� r f `'' "
�' � �� ��� ,
Phone No. y _
ZI � Code: 34952 Fax: 772-335-2680
E -Mail:
Phone No. 772-337-3682
Fill in fee simple Title Holier on next page if different
E -Mail: genesispiumbingservices@gmail.corn
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 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.
,. ;'-err % ✓���'.�,-.� .��Y
Signature of OwnerlLe5seei"'[Contractor as Agent for Owner
STATE OF FLORIDA`,, ,
COUNTY OF ._-)+
The forgoing instrument was acknowledged hafore me
this
(Name of person acknowledging )
(Signatu"re-6f Notary Pubk - State of Florida }
y .,'`*Tray, Pr��lel�tl'i%�tZ
Personall Known ,+
Type of Identificati 'f Commission # GG 97150
"s .: y ommFssran ex9
Apr �. �V i1
Commission No. ,
Revised 07/15/2014
REVIEWSI FRONT
COUNTER
DATE
COMPLETE
INITIALS
re
STATE OF FLORIDA
COUNTY OF " r'
The forgoing instrument was acknowledged before me
this74ca'of t� 2C by
(Name of person acknowledging)
(Signature of Notary Public- Slate of Florida )
.,,..,r
Personally Known •- ,�� ; �,,�1},i Prq�E��lpde3�tiflii�di�ifffz
Type of ldentificati - °o ` El commission # GG 97150
=
rvfy Commission xpare
"•aP/L 11 April 021
Commission No. .,'rra aaaN``
ZONINGI SUPERVISOR PLANS VEGETATION I SEATURTLE MANGROVE
REVdEW i REVIEW REVIEW REVIEW REVIEW REVIEW