HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TOBEACCEPTED
Date: Permit Number:
'i MM-Mml-
Building Permit Application
Planning and Development Se/vices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce B34982
Phone: (77Z)462'1SS3 Fax: (77Z)462'1S7U [.OUODlerCi8/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:*
Legal Description:-
PropertyTax |D#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Ri0htSide: Left Side:
________
LDETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name
JOSEPH F TULLY
Additional- w_o_rI�__t_o_be nertormed under
this permit – check
–]Gas
all h t apply:
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
PORT ST LUCIE FL
City: State:
Zip Code: 34952 Fax: 772-335-2680
Phone No. 772-337-3682
Piping
E -Mail: genesispiumbingservices@gmaii.com
S h utters
P
17-71
E]Sprinklers
Electric LLLJ Plumbing
Generator
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
of First Floor: —
Utilities: E Sewer FISeptic
Building Height:
OWNFRAESSEE:
CONTRACTOR:
Name
JOSEPH F TULLY
Address:
Company: GENESIS PLUMBING SERVICES INC
city: state:
Zip Code: Fax:
Phone No.
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
PORT ST LUCIE FL
City: State:
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: genesispiumbingservices@gmaii.com
State or County License: CFC1429103
It value ovconstmctio is $2S00o,more, aRECORDED Notice o^Commencement is requ/rem.
SUPPLEMENTAL CONSTRUCTION LEEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
COUNTY OF
Zip: Phone:
BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: 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 Countyy 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 nr rernrrlina un„r ninth. --F r� ,n �I
C"t,Ciil
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Signature of Owner/ -Luse` d/Contractor as Agent for Ownerignature
of Contractdr/License'fTtYIder
STATE OF FLORIDA, T „
STATE OF FLORIDA
COUNTY OF ' J
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of - 20 _by
this day of 20 by
(Name of person acknowledging) t
(Name of person acknowledging )
jc�'
(Signatute-6f Notary Pubkc- State of Florida)
(Signature of Notary Public Slate of Florida)
PersonallyKnown '�;':ar"a'j Pr &eh1tffie Z
Personally Known ,•«""��
Y ..R Prq�pAetP�Z
Type of IdentificatiI Commission # GG 97150
Type of Identificati°o i Commission # GG 97450
iy .ommission xp,
y
No. "�,,,,,,,. Aprl 24 2021
_* -
SZ °<r My commission Expires
"'w',;�o,ry April 021
Commission No. ��,
,,,
Revised 07/15/2014
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COUNTER
DATE
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INITIALS
ZONING REVIEW I S REVIEWOR I REV EW I VREVIEWON I S REVIEW LE I MREVIEW