HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
2��,�
` - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 4 �)i
Legal Description:
Property Tax ID #: _ �� � �� b�J-��J�o��j �� r Lot No. t
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Adclitionalwar c nbepertormed under this permit - c ec a t apply:
�HVAC Gas Tank Gas Piping 5hutters Windows/Doors
Electric .Plumbing Sprinklers 1:1 Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
SC0Sewer
Ft.
of First Floor:
Utilities: 7Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: JOSEPH F TULLY
Andress: 1 iQk
Company: GENESIS PLUMBING SERVICES INC
City. L State: i_
Zip Code: Fax:
Phone No. _l [no- ` - '-Vg
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 Folder can next page (if different
from the Owner listed above)
E-Mail: genesisplumbingservices@grnail.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:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Name:
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 aN 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/ se6[Contractor as Agent for Owner gnature of Contractor/License` " oIder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -� COUNTY OF 'L
-°.
The fQrg. i g instrument was acknowiedge dAefore me
this I agy Of _4.��. 20 t�jby
(Name of person acknowledging )
{Signature of Notary Public State Wof Florida)
Personally Known ,��RYo Pr��lekkt�fFC�tFz
Type of Identificati commission #f GG 971 50
y Commission x
Commission No.
07/15/2014
The forgoing instrument was acknowledged efore me
this i KPi ay of `� \,i 20 9 by
(Name of person acknowledging )
[Signature of Notary Public- State of Florida )
Personally Known +++`,"; 1RPrc3*4mA9AeJAHiEdtQJKZ
Type of Identificati o f commission # GG 97150
�i
` My commission xpue
°-�� April oil
Commission No. '��+, +++`°`
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