HomeMy WebLinkAboutbuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462--1579 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
ko
Legal Descriptio ] C \i �e
Property Tax ID #:Site Plan Name:
Project Name:
Setbacks Front Back;
Might Side: Left Side:
Lot No. I�
Block No.
DETAILED DESCRIPTION OF WORK:
t f__CA 1 � �cx I lam, 1 car, c i ir"
CONSTRUCTION INFORMATION:
tiona wor to be erformed under this permat— check a t apply:
�HVAC Gas Tank Gas Piping _Shutters Windows/Doors
DElectric _Plumbing []Sprinklers El Generator F-1 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _OQQ�
5 Ft. of First Floor: _
Utilities:0 Sewer El Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namey\'J\0 �rnx\
Address: L
—1 e --
Name: JOSEPH F TULLY
Company: GENESIS PLUMBING SERVICES INC
City` -=j _��--
Zip Code:
Phone No. q`�!
• �L�C�� State: 0-
Fax:
— i Q�'R Ca
Address: 1532 SE V[LL4G)=GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
Zip Code: 34952 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)
E-Mail: genesisplumbingservices@gmail.com
State or County License: CFC142P103
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
[DESIGNER/ENGINEER:Not ApplicableMORTGAGE
COMPANY: Not Applicable
ame:
Name:
ddress:
Address:
City: State:
Zip: Phone:
City: State:
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 recording your Notice of Commencement.
-signature of Own et% see/Contractor as Agent for Owner gnature of Contract r/Licensee bI&r
STATE OF FLORIDA,,--.., STATE OF FLORIDA
COUNTY OFt i -u C"I COUNTY OF
The for g instrument was acknowledged hefore me
this: 1 y of Z` 20_;2_by
(Name of person acknowledging)
(Signature "of Notary Public State of Florida
Personally Known ',"�'"j prtRld�leF4t�if-t�t�
a .. .
Type of Identificati Commission # GG 97150
S' y ammtssion Expires
Air} 24 2021
Commission No. ""��,""
Revised 07/15/2014
The fort' g instrument was acknowledged before me
thray of f�,li�'1 20 ti by
'� r•, f
(Name of person acknowledging)
-(Signature of Notary Public- St'ate of Florida )
Personally Known ";';'fyd}2 Prq�leJYtt�dt4tii�
Type of Identificati o ``4d commission # GG 97150
=*
=N t. My Cornmissson xpaa
Aprl1
Commission No. '����;';��•� 021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS