HomeMy WebLinkAboutBuildiling Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c--2 Cil �. Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ti
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: I c t) C) �V 0 �Z�V' i l
Legal Description.
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK: f
61&'k1 tin
CONSTRUCTION INFORMATION
Additional work to b
[{rtormed under this it— c ec t a [t{ appy:
11.
1HVAC L,,.._j Gas Tank ❑Gas Piping L =1 Shutters Windows/Doors
Electric ` Plumbing []Sprinklers LJ Generator 1J Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (. '0 b
5 Ft. of First Floor: _
Utilities: Sewer D Septic
Building height:
OWNER
LESSEE:
CONTRACTOR:
Name' �
"`� `�
'( z
Name: JOSEPH F TULLY
Address:
0a 0_Q
�
Company:. GENESIS PLUMBING SERVICES INC
City:
Zip Code:
Phone No.
� a , U
� Q 9 \4v Fax:
C State: L
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: genesisplurnbingservices@gmaii.com
State or County License: CFC1429103
It value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: s Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
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 your Notice of Commencement.
Signature of Owner
&esee�Contractor as Agent for Owner lgnature of Contra ctdr/License FF61der
STATE OF FLORIDA.., STATE OF FLORIDA
COUNTY OF `;4- 3 , ', COUNTY OF ,
The forgPing instrument was acknowledged fore me The for o.n instrurntawas acknowledged before me
this day of � , 20 �y this day of y �`` 20 by
—�-+ �-'�tr �--�_a. c` C �`, f 'r `` ln',".= r •�- �T t _�'_ " � 1( . f e � C ;1�� l{_ � _ t �t—� � �.
(Name of person acknowledging) (Name of person acknowledging)
(signature of Notary Public- State of Florida)
yi1171ry
Personally Known �'.*•_ I�r�iekltPffctZ
Type of Identificati a Commission # GG 9715D
'sy a - y ommission x G
Commission No. ",, `" Aprl 24 2023
Revised 07/15/2014
of Notary Public- State of Florida )
Personally KnownR Prc5A"AW$LeJANiEJiQffZ
I`
Type of IdentificatioY • commission # GG 97150
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re iYIY Commission XQIS85
Commission No. ,;",Apri1 021
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