HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO RE ACCEPTED
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Date: { Permit Number:
1.- ,
r Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982i
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: 77A 0= 3 k_: �A" L --
Legal Description: -A \:
Property Tax ID #: — `~ F� r f r
L� �. 0M Lot No
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional wor < to leperormed un er t is permit— check all that apply:
�HVAC LJ Gas Tank Gas Piping F Shutters Windows/Odors
Electric Plumbing Sprinklers Generator Roof C] Roof pitch
Total Sq. Ft of Construction: f
Cost of Construction: $ Cry'
S.Ft.Jj of First Floor:
utilities: :]Sewer 0Septic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name r - ��s r� 1'�
Name: 30SEFH F TULLY
Address: `tom C)
Company: GENESIS PLUMBING SERVICES INC
City: r�r �1°� �'.. t _ State:
ZipCade: �i Fax:
Phone No. -Dr) ___5 L.0-_
Address:532 SE VILLAGE GREEN DRIVE UNIT B
City:'OF;T ST LiJCEE State: FL
Zip Code: 34952 Fax: 772-335-2680
Phone No. 772-337-3682
E-Mail:
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
E-Mail: genesisplumbingservices@gmaii.com
State or County License: CF01429103
If value of construction is $2500 or more, a RELUK111W 11ionce OY I VMMence1T1UF1L Lb ICLJUEICU.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
_Not Applicable
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/ seejContractnr as Agent for Owner _ ignature of Contra ctdr/Licenses older
STATE OF FLORIDAt , i STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgoing instrument was acknowledged�efore me
this day of 20 Eby
(Name of person acknowledging)
(Signat& of Notary Public Sta>e of Florida) "
Personally Known �;.R*� j PrcodtR alahPtFf��i Z
Type of Identiflcati ` Commission # GG 971 50
y ommission xpir
Commission No.
�„°;,;,Aprl 24 2021
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this ,'day of " ✓ 20 t by
(Name of person acknowledging)
(Signature of Notary Puhlic- 5tate of Florida )
Personally Known "°; R Prq $A90LeJANiEd Z
Type of Identifieati ` d commission # GG 87150
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m COmmiss on Expires
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Commission No. % °'t�'`
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SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
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INITIALS