HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i i i
Permit Number:
ems`
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED` IMPROVE
Address: ?'a2A0
Legal Description: �# )6
#n
Commercial Residential
To Select from dropbox, click arrow at the end of line
LOCATION:
Property Tax ID #: S - - a ` t
Site Plan Name: !
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. -
Block No.
CONSTRUCTION INFORMATION:
A it((iona wort to e er orme un er t is permit- c ec a t app y:
0HVAC FJ Gas Tank ❑Gas Piping 7Shutters E Windows/Doors
Electric 1E Plumbing Sprinklers nGenerator 7 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (_v-
SFt. of First Floor: _
UtilitiesInSewer 7Septic
Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name a -
Name: JOSEPH F TULLY
Address:_
City: Loa State:
Zip Code: 4 54q Fax:
Phone No. • '�
E -Mail:
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
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: genesispiumbingservices@gmail.com
State or County License: CFC1429103
- .1 -11 3 4Juv or rnure, a 11M.UKUtU ivotice or Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name: MORTGAGE COMPANY: Not Applicable
Address: Name:
City: Address:
Zip: State: City: State:
Phone: Zip: Phone:
FEE SIMPLE TITLE MOLDER: Not Applicable BONDING COMPANY:
Name: _Not Applicable
Address: Name:
City: Address:
Zip: Phone: City:
Zip: Phone:
I certify that no
work or installation has commenced prior to the issuance of a permit.
which is in contflict with any applicable�Ha eaOwners Association rules, bylaws or andpcovenantdsthat maydrestr,ct orproh bit 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.
a Signature of Owned/_ see/Contractor as Agent for Owner
g gnature of Contract r/1 irancry Pii4cr
STATE OF FLORIDA + I STATE OF FLORIDA
COUNTY Of COUNTY OF
The fort instrument was acknowledged hefore me The 1f000fn'instrument was acknowledged before me
this cfay of K20� aby thisay of
11 pi y" 20 � by
(Name of person acknowledging)
L
(Signatur=e ofNotary PubLrc-Stale of Florida) 7 -
Personally Known..,`°e i.0
"� Pr dah�tPFli�t
Type of Identificati I Commission # GG 97160
Orf °o� y ommission X 1
Commission No. ` °`�' Aprl 24 2021
Revised 07/15/2014
(Name of person acknowledging)
ature of Notary Public -,State of Florida )
Personally Known R Pr(Zd�gAetANrCdiOffZ
Type of Identificati'°o Commission # GG 97150
:x
My Commission xpires
Commission No. +9'% °„° April 021
REVIEWS FRONT ZONING SUPERVISOR PLANS
TE COUNTER REVIEW REVIEW REVIEW
DA
COMPLETE
INITIALS
VEGETATION f SEA TURTLE I MANGROVE
REVIEW ( REVIEW REVIEW