HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I _4 J, -f
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` A
Lot No.
Property Tax ID #:
Site Plan Name: Block No.
Drn is KI—P
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
chec a t at app y:
Additional work to b erform i:; 1: 21 iis permit— t_=1Shutterswindows/Doors
EHVAC Gas Tank ❑FIGas Piping
Electric ElPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: —
Utilities: 0 Sewer []Septic
Building Height: _
OWNERAESSEE:
CONTRACTOR:
Name am
Name: JOSEPH F TULLY
Company: GENESIS PLUMBING SERVICES INC
2 SE VILLAGE GREEN DRIVE
Address: 153 UNIT B
Address: 7
State:
City: PORT ST LUCIE State: FL
City:
Zip Code: Fax:
Phone No.
Zip Code: 34952 Fax: 772-335-2680
Phone No. 772-337-3682
E -Mail:
E -Mail: genesispiumbingservices@gmail.cOm
Fill in fee simple Title Holder on next page if different
State or County License: CFC1429103
from the Owner listed above)
If value of construction is5z!iuu or more, a KtLUKUru
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:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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.
Signature of Owner/le/Contractor as Agent for Owner gnature of Contractdr/License alder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF F "I
I COUNTY OF
The fix oing instrurpent 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) (Name of person acknowledging )
(Signature of Notary Public- State of Florida).
\56�i�if Pr bel�PtPiZ
Personally Known
Type of Identificati Commission # GG 97150
3or` y Commission Expi
11'11 °n Apr{)2d 2021
Commission No.""""`"�
Revised 07/15/2014
(Signature of Notary Public -,State of Florida) "
Personally Known"Mill".�}2 PrcgApAeiodMf MTez
Type of Identificati _"0 `ed Commission # GG 97150
_
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Commission No. %`,°` It,April 021
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