HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE} INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l 1l� Permit Number:
- _ Buflcltng 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: ��� c-a L—'�' - i
Legal Description: � A
Property Tax Id #: 7J',--,:�>Li — " 0SX-N D Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional wor c to jeer arme un er t is permit — c ec a app y:
0 � Windows/Doors
�HVAC Gas Tank ❑Gas Piping _ Shutters
❑ Electric ape Plumbing Sprinklers ElGenerator Roof Roof pitch
Total 5q. Ft of Construction:n Sq. Ft. of First Floor:
0 7Septic Height:
Cost of Construction: $ l'� r Utilities: Sewer Building
OWNERAESSEE: CONTRACTOR:
Name Name: JOSEPH F TULLY
Address: kC'!Ii O L mp L Q— :I_. Company: GENESIS PLUMBING SERVICES INC
.
State:47L Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
Zip Code: ��� �aS� Fax: City: PORT ST LUCIE State: FL
Phone No. �) `�� ' '"� Zip Code: 34952 Fax: 772-335-2680
E--Mail: Phone No. 772-337-3682
Fill in fee simple Title Holder on next page ( if different E-Mail: genesisplumbingservices@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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: i
DESIGNER/ENGINEER:
4 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:
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
commencin work or recording your Notice of Commencement.
Signature of Own eV see�Contractor as Agent for Owner gnature of Contra ctrir/License olde' r
STATE OF FLORIDASTATE OF FLORIDA,
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged hefore me
this day of Y 20 _by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida }
Personally Known fj PrahPtPF>i �l
Type of ldentificati Commission # GG 973 5i3
o. y amm�ssion x
jfan", ` Aprl 24 2021
Commission No.
Revised 07/ 15/2014
The forgoing instrument was acknowledged before me
this day of
(Name of person acknowledging }
20 by
(Signature of Notary Public- state of Florida }
Personally Known ",';b}i Prc{ldpeh�i�TcdZ
Type of ldentificati o ° d Commission # GG 971510
t- My Commission xplre
Commission No. 71OF10 April 021
151
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