HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: oA 1Cl 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: 1:-_�>1 }LCM-4 —( G `V
Legal Description:--p
Property Tax I #:
Site Plan Name:
Project Name:
Setbacks Front Back
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lcojx- r
CONSTRUCTION INFORMATION:
Additional work to e e or nr un er t is permit — c ec a app y:
11HVAC Gas Tank ❑Gas Piping _ Shutters
11 Electric ILSI Plumbing Sprinklers E] Generator
Total Sq. Ft of Construction:
Cost of Construction: $ '�) M
OWNER/LESSEE:
Name .lam rs "
Zip Code- U V ax:
Phone No.1
F-NAait
Sq. Ft. of First Floor:
Utilities- 0 Sewer D Septic
State:' L--
Fill in fee simple Title Fielder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: JOSEPH F TULLY
Lot No.
Block No.
0 Windows/Doors
F]Roof = Roof pitch
Building Height:
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
phnna r\In 772-337-3682
r-\n,);i. 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: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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
L,UJ11t11t--11L,111r, vvurK Ur recuraing your iNouce or t-ommencemem.
Signature of Own etZ . see/Contractor as Agent for Owner gnature of Contra ctdr/Licenses° ol�4
STATE OF FLORIDAty STATE OF FLORIDA
COUNTY OF
COUNTY OF f r l
The forgoing instrument was acknowledgedefore me
this day of � QQ(, 20 J:Aby
Yam__
(Name of person acknowledging)
C - i
(Signature of Notary Public- State of Florida ]
y ,........
,,1J1, PraAR AIeJI*R C € Z
Personal) Known ''.�.'��YP
Type of Identificati 'I Commission # GG 97150
=y '= y ommissian x I
�'�"'`� fl�A,, April
24 2021
Commission No. """""'���
Revised 07/15/2014
The forgginn�.g instrument was acknowledgedefore me
this�w day of �- 20 a by
(Name of person acknowledging )
ignature of Notary Public -State of Florida )
Personally Known PrcbJmA iA NiEdtoffZ
Type of Identificati °o fi Commission # GG 97150
=*
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