HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
a
Date: y 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:
Address: UO'd 00,
Legal Description: t -e i ne-
Property Tax ID #: (D <)I rl - Q) 013 Lot No. le
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET AILED DESCRIPTION OF WORK:
� a1Ce
CONSTRUCTION INFORMATION:
Additional work toe oertormed under this permit– c ec a t appy:
F]HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
17771
Electric =°' Plumbing Sprinklers E2 Generator u Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
(
Utilities: 7Sewer [—]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR;
Name
Name: JOSEPH F TULLY
Address: \2
City: �� r'`-�`-P [�Y'i' i State: __
Zip Code: 5( ?q Fax,
Phone No. `( -1
',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 above)
E -Mail: genesispiumbingservices@gmail.com
State or County License: CFC1429103
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -
DESIGNER/ENGINEER: N t A I'
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— o pp icable
State:
— Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip:
one:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
. Lucie
wthich is incon, li makes ith army applicable iHo eaOiwne s Association nting a irulill esaby bylaws outhorize r andpcovenantss that build
drestrict ojrprohibits 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.
_ „._.,,�-�:�'� ,��'` fir✓"_ �--
Signature of Owner/-L;essee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF w ,l COUNTY OF
The forggg instru�.nt was acknowledgedbefore me The forgoing instrument was acknowledged efore me
this 1 2 of s.�
20 �a by this day of r-� 20C 11
by
(Name of person acknowledging)
--...-. (Name of person acknowledging)
i3+gna>:ure or iNotary Pubfit- Stai;e of Florida) <"
xb
Personally Known ,,,*tW7.P� pr �ekftPfFc�t�Z
Type of Identificati Commission # GG 97150
l�,pf�nop,<� y omm+sswn x +s .
Commission No. ''"7t7++ "Apri 24 2021
Revised 07/15/2014
azure of Notary Pu' blic-$tate of Florida )
Personally Known ,.j77y; R Prq Ap01�gMilt Z
Type of Identificati .'"°o `+"d Commission # GG 97150
vy <e My Commission xpires
Commission No. "%%,°,,,`,P� Aprll 021
REVIEWS
D ATE
COMPLETE
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
INITIALS