HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tPermit Number:
5
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: c"t``
PropertyTaxlD#:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION OF WORK:
Lot No. -;
Block No. `' I
Left Side:
C1
CONSTRUCTION INFORMATION:
Additional work to be
per orme un er t is permit — c ec all th t app :
HVAC L �J Gas Tank ❑Gas Piping In Shutters Windows/Doors
FlElectric Plumbing L _1 Sprinklers FIGenerator F]Roof Roof pitch
Total Sq. Ft of Construction
Cost of Construction: $
Sq. Ft. of First Floor: —
Utilities:Sewer 7 Septic
Building Height:
OW N ERAESSEE:
CONTRACTOR:
'-
Name � � .� � �+� � -� � �F ��
Name: JOSEPH F TULLY
Address: (7'
Company: GENESIS PLUMBING SERVICES INC
City: �� -�� e�' State. - r
Zip Code: Fax:
Phone No.�l t1 `' i _
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: n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed abode)
E -Mail: genesisplumbingservices@gmaii.com
State or County License: CFC1429103
If value of construction is 525UU or more, a KtLUKUru IVULIGC Ul —4- c.q- .
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
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 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 pians, 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/ 01contractor as Agent for Owner - lgnature of Contractdr/Licens�Fiolder ^
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF . - .-- COUNTY OF h �,
The forgoing instru:rpent was acknowledged hefore me
this ei clay of `" 20 °.. `� b
`' ''' "� y
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
Personally Known.°:��"� Pr de#�PtPiFctP
Type of Identificati Commission # GG 97150
:r o Y Commissrossngg(rygyyxgpq�
Commission Na.
Revised 07/15/2014
The forgoing instrument was acknowledged ,before me
this day of 20 by
Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personal) Known °'°"'
Y r.,�bR PrcE4MkiqAet-AMiEdWfz
Type of Identificati°o '"f� Commission # GG 97150
My Commission xpues
Commission No. �r4%%;° ;;°' April
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS