HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:a. �� 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED imPROVEMENT LOCATION:
Address:
Legal Description:—
Property Tax ID #: Lot No.
Site Plan Name: Block No. ,.2'
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional wor to be performedunder t is permit— c 112 1. 11, a t at app y:
HVAC I—J Gas Tank ❑Gas Piping E_ Shutters Windows/Doors
Electric Plumbing Sprinklers E] Generator Roof Roof pitch
Total Sq. Ft of Construction S Ft. of First Floor:
Cost of Construction: $ (cl-- "' "'� Utilities: 7Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
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Name �V", � ��� � i �� `� �-a�,,,� _. °�_a
Name: JOSEPH F TULLY
Address 1 °� . I �% �;j�
Company: GENESIS PLUMBING SERVICES INC
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
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City. } . Z,.CA'1 '� E' State:r �
City: PORT ST LUCIE State: FL
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Zip Code:1 Fax:
e34952
Phone No. � f��j�� : �,�; �—� � � $i°�
Zip Code: Fax: 772-335-2680
Phone No. 772-337-3682
E -Mail:
Fill in fee simple Title Holder on next page { if different
E -Mail: genesisplumbingservices@gmall.com
from the Owner listed above)
State or County License: CFC1429103
It value of construction is szsuu or more, a Ktl.urcuty wvuc.c v� wuu••c•.ac...... �h—••---
SUPPLEMENTAL CONSTRUCTION LIEN" LAW. INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 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.
Sgnature of Owner/see%Contractor as Agent for Owner <_. gnature of Contractdr/License'Ffbld`er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ; COUNTY OF
The f r mg instrument was acknowledged hefore me
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this 6 °"day ofi:. 20 by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
Personally Known '.`,PR*"%` PrehftiiECt Z
Type of Identificati Commission # GG 37150
P,Z: y Commission xpi
Commission No. �.,,,o�M1o, Apri 24 2021
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this day o 20 by
f
(Name of person acknowledging )
'(Signature of Notary Public- State of Florida )
Personally Known }i Prq0UwA9AeJAHitdQ5KZ
Type of Identificati o �d commission # GG 97150
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Commission No. unua��
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS