HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ 'l l �f Permit Number:
V7
OR!
�.
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: l ' �` t i Cr. 2,1_ )'J(I , 5
Legal Description: >r i; _. �. 4 r` �' Le.
Property Tax I 4: ; ; _ t , �r i ��� Lot No. =...._ i
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I Svj as �� Cc-,�` �'` �(,:'Y� L- C ��- k ,4;- f f
CONSTRUCTION INFORMATION
Additional workto e er orme un er t €s permit- c ec a app y:
EIHVAC Gas Tank �Cas Piping _Shutters Windows/boars
El
11 Electric Plumbing Sprinklers Generator E]Roof iRoof pitch
Total Sq. Ft of Construction: SQ. Ft. of First Floor:
Cost of Construction: $
lil : C - Utilities: Dewer Septic Building Height:
_
OWNERAESSEE: CONTRACTOR:
Name _ �i -�� �' � `� Name: JOSEPH F TULLY
Address: L� tomE i l Company:GENESIS PLUMBING SERVICES INC
ii -)..- F` E
City: "� T «- L-C ('_ Staters Address 1632 SE VILLAGE GREEN DRIVE UNIT t3
Zip Code: � 4�9 �1 Fax: City: PORT 5T LUC1E State: FL
Phone N Q'; Zip Code: 34952 Fax: 772-335-2680
E-Mail: Phone No. 772-337-3682
Fill in fee simple Title Holder on next }sage (if different E-Mail: genesisplumbingservices@gmail.com
from the Owner listed above) 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:
1 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 vour Notice of Commencement.
�7 1
el —
'Signature of Own er/-Les-s-eeTContractor as Agent for Owner :.-:---STRnature of Contractor/License o1H der
STATE OF FLORIDA,, . STATE OF FLORIDA
COUNTY OF + COUNTY OF
The € ping instrupent was acknowledged before me The for ping instrument was acknowledged before me
this { day of ,__...�20 ( by this E day of `� ZO by
rA
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public'- State of Florida }
Personally Known Pr&AtRMAIelARFt&<kffZ
Type of Identificati Commission # GG 97Y 50
y commission x ifes
Apr1IF1.411 2011 _J
Commission No.
Revised 07/15/2014
(Signature of Notary Public- Sfate of Florida) R
Personally Known +�',`; }R Pr vA 9ALeJAHkdtOffZ
Type of ]dentificati _ °o `".� commission # GG 97150
_* =
= My commission xP sr6s 11
- �<
'=i'tv.��; Aprti O21
Commission No. ���� „++
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS