HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -- ! I ° = Permit Number:
"'=
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1578 Commercial
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:i
_ ,f
i
C
a l
Legal Description: _ _ i - s'
Property Tax 1D #: b Y{ R „ g4' �� 'p `- Lot No. i d
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
M10.c
CONSTRUCTION INFORMATION-
NFORMATION:
CONTRACTOR:
a r t.--
Name e�`"� T � � � �- �� 14
Name: JOSEPH F TULLY
Arc ditiona wor tobe ertormed under this permit— Check—lla
Additional
thi tapp :
City: State:.
HVAC i _J Gas Tank
F]
Gas Piping
_
Shutters
Windows/Doors
nElectric Plumbing
E -Mail: genesispiumbingservices@gmail.com
Sprinklers
1-1 Generator
Roof Roof pitch
Total Sq. Ft of Construction:
Sq.of First Floor:
7
Cost of Construction: $ ° k I i.a
�a� Utilities:
Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
a r t.--
Name e�`"� T � � � �- �� 14
Name: JOSEPH F TULLY
Company: GENESIS PLUMBING SERVICES INC
_!7x'-___
Address: � �J
City: State:.
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
Zip Code: 7 Fax:
Phone No.
Zip Code:34952 Fax: 772-335-2680
E -Mail:
Phone No. 772-337-3682
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 is 52500 or more, a KELUKUtU Notice or t-UMmencerr]erIL 15 1 MiUlt cu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE BOLDER: — Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 thepermit 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 OwneG/ ' -Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF,
i). �--, �. ori �_ COUNTY OF
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this *dayof.R- 20 ';by this \,,:da y of- ` d' 20 I by
„�
(Name of person acknowledging) (Name of person acknowledging )
(SlgnatGre ofNotary Pubkrc- State of Florida )
Personally Known ;:`��Jr" Pr4e1#t9f&r#Z
Type of Identificati r �r dig{ Commission # GG 97150
o< y ommisssonxp
Commission No.
,",;,;;, Aprl)24 2021
Revised 07/15/2014
of Notary Public- State of Florida )
Personally Known °'Y. R Prq ApdeJ-ANiEd1OffZ
I
Type of Identificati°o ` d Commission # GG 97150
My Commission Expires
OF��.,' April 021
Commission No. 11
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS