HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater �� i 'i',� 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:
_ r
Address:
Legal Description:
Property Tax 1D #: �1 ` r~x - Lot No.
Site Plan Name: Block No.
Prnipct Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
7a 1, 44D
CONSTRUCTION INFORMATION;
Additional work toer orme e un er t is erm tt— c ec a a y:
(�j p p p
HVAC L_1 Gas Tank DGas Piping _ Shutters Windows/Doors
FlElectric Plumbing Sprinklers F]Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: 0 Sewer 7 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address:
City State: _+
Zip Code: Fax:
Phone No. r r _
Name: JOSEPH F TULLY
Company: GENESIS PLUMBING SERVICES INC
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City_ PORT ST LUCIE State: FL
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 abode)
E -Mail: genesisplumbingservices@gmail.com
State or County License: CFC1429103
if value of construction is $2500 or more, a KtLUKutu Notice Vl %-Ul1���� _� c••� •� •�-,~••�~
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 vour Notice of Commencement.
f.P
Sf96ature of Owner/ -Le seC[Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF -' ;_ t
The foring instruent was acknowledgedbefore me
thisa day of 20 =by
STATE OF FLORIDA
COUNTY OF�
The :forgoirig.instrument was acknowledged -,,before me
this day of 120 by
(Name of person acknowledging) (Name of person acknowledging )
4
(Signature of Notary Public- State of Florida
Personal) Known�°:�a.°
Type of Identificati ' Commission # GG 97150
:a crc y Commission Expire
Aprl 2d 2021
Commission No.
Revised 07/15/2014
nature of Notary Public -_State of Florida )
Personally Known Prq A9 Z ri
Type of Iden tificati* od Commission # GG 9715
,y o My Commission xp�res
Commission No.
REVIEWS
FRONT
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SUPE/RVISOR
PLACNS/
VEGETATION
SEpATUR^TLE
SERA
MANGROVE
COUNTER
REVIEW
REVIEW
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IL VVI
REVIEW
DATE
COMPLETE
INITIALS