HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _. 2�}.�0 `1 \ q Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginio 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:
Legal Description:
Property Tax ID #: L 00 � o " Lot No. I 4- Li
Site Plan Name: Block No. -`
Project Name:
5etbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to er orme r
under this perm
❑HVAC 1 Gas Tank Gas Pi
Electric 0 Plumbing �Sprinl
Total Sq. Ft of Construction:
Cost of Construction: $��
Windows/Doors
goof = Roof pitch
Building Height:
OWNERAESSEE: CONTRACTOR:
Name o-c ' _ /a ;o, ,,::S mod- Name: JOSEPH F TULLY
Address: I 'Itn 1 cI Company, GENESIS PLUMBING SERVICES INC
Com an
City: �'�- -- � � ce
State: _L Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
Zip Cade:_ Fax: City: PORT ST LUCIE State: FL
Zip Fax: 772-335-2680
Phone No. t-� �-� ` � � � J' �P Code:
E-Mail: Phone No. 772-337-3682
Fill in fee simple Title Holder on next page ( if different E-Mail: genesisplurnbingservices@gmail.corn
from the Owner listed above) State or County License: CFC1429103
i
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
- check all apply:
ng Shutters
=rs ❑ Generator
Sq. Ft. of First Floor: _
tltilitses: 0 Sewer F]Septic
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
commencing_work or recording your Notice of Commencement.
Sig"nature of Own er%LesseefContractor as Agent for Owner 1&ature of Contra ctdr/License-Rd-Ider
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ' -rL., COUNTY OF. �_•_�Fd
The f r ing instru nt{as acknowledged efore me The forgpjng instrument was acknowledged before me
this ay of \A- 2p I''lby this wffly of �-c 20 by
(Name of person acknowledging } (Name of person acknowledging l
(Signat0re'6f Notary Public- State of Florida
Personally Known ';t� PrRJWR
BIeIPIZ
Type of Identificati) Commission # GG 97150
ommission x
Commission No. 21
Revised 07/15/2014
(Signature of Notary Public- S`ate of Florida }
Personally Known "y; j�bR Prq A90LeJANiEAQf fZ
Type of Identificati°o fi commission # GG 9715
=* =
of My Commission Expires
Commission No. %f,`";d April 021
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