HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
S -
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:
OCATION:
Address: "
Legal Description:
Property Tax ID #: i" �; �� a. N - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional wor c to(eler orme un er t is permit — c ec a at appy:
HVAC I_J Gas Tank Gas PipingShutters Windows/Doors
FlElectric �'
' �Plumbing QSprinklers [:]Generator F Roof Roof pitch
Total Sq. Ft of Construction
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities:Sewer 7Septic
Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name - k
Name: JOSEPH F TULLY
Address: "
Company: GENESIS PLUMBING SERVICES INC
City: State: _l_
Zip Code: Fax:
Phone No`. s C—I — _
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
Zip Code: X952 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
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTRUCTION LEEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE C
Name: _
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
OMPANY. Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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.
Signature of Owner/ -L see7Contractor as Agent for Owner �
g mature of Contractor/i iranc� HtFior
STATE OF FLORIDA,,,, STATE OF FLORIDA
COUNTY OFr_ COUNTY OF
The forgoing instrument was acknowledged before me
this . day of 20 '_'by
(Name of person acknowledging)
a
(Signature of Notary Pub}ic- State of Florida)
Personally Known
Type of Identificati Commission # GG 9716
o—Mm ISalo n Expires
Commission No. `'`+++�++�"`� Aprl 24 2021
Revised 07/15/2014
The forgoing instrument was acknowledged,before me
this day of 20 by
(Name of person acknowledging)
(Signature of Notary Public- Sfate of Florida)
Personal) Known
Y ..rR Prq�{p�ell�iidi42R�Z
Type of Identificati+°o "EI Commission # GG 9715
My commission Expires
Commission No.%%;°P m`' April 021
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS