HomeMy WebLinkAboutBuidling PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/11/2019
Permit Number:
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OEM-
-000��
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1.553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 10101 Spyglass Ln, Port St Lucie 34986
Property Tax ID #: 3327-707-0025-000-4
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
install 50 gallon I/p gas water heater in the garage
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit –check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
Electric Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cast of Construction: $ 800.00 Utilities: _Sewer —Septic
Lot No. 21
Block No.
Windows/Doors
— Roof Pitch
Building Height,
OWNER/LESSEE:
Name Keith Ashby
CONTRACTOR:
Name. Joseph F Tully
Address: 10101 Spyglass Ln
Company:Genesis Plumbing Services
City: Port St Lucie State: _
Zip Code: 34986 Fax:
Phone No.(772) 461-3032
Address: 1532 SE Village Green Dr Unit B
City: Port St Lucie State: FL
34952
Zip Code: Fax: 772-335-2680
Phone No 772-337-3682
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of Construction is S250n nr mnre n Pvcn lnrn
E -Mail genesisplumbingservices@gmail.com
State or County License CFC1429103
- - 01 w 111 cncerr min is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL. CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ 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
commencing work or recordin our Notice of Commencement.
�- .5 'nature of OwnetJl s26/Contractor as Agent for Owner— gni a# re of Contractor/License—fl-61der
STATE OF FLORIDA:., _ STATE OF FLORIDA
COUNTY OF �COUNTYOF _l
The forgoing instru e t was acknowledged fore me
this day of %V 20 by
��x�— �c'; �--� ��'•=7 .sem
(Name of person acknowledging)
(Si gnatuti? of Notary Publie State of Florida)
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Personally Known ,;�R,. Pr&kRWhAAffrti9dJ9Z
Type of Identificati 1 Commission # GG 97150
y Commission x
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Commission No. ""°`" Apr! 24 2021
Revised 07/15/2014
The forgoing instrum nt was acknowledged before me
this 11 S day of 1i , 20 by
r_-_.
(Name of person acknowledging )
(Signature of Notary Public- Siate'of Florida j
Personally Known .,",'; R Prc�"mA0A NiE36 fZ
Type of Identificati -',o `'EI Commission # GG 97150
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'!P•��' Aprll
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