HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:%' Permit Number:
ORO
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:
Legal Description: C� Gf 1 Un ��-
(Y yqi ii:: "3
Property Tax I #: -Zf-> 1-2 _ Lot No.-
51te Plan Name: Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�J
CONSTRUCTION INFORMATION:
Additional work to beperformed un er t is pm erit— Check all ht apply:
1:1 Piping Shutters Windows/Doors
{HVAC _J Gas Tank Gas
F]Electric X Plumbing O Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
,
TCost
of Construction: $ �'' , � Utilities: Sealer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
�-
Name {`
Name: JOSEPH F TULLY
Company: GENESIS PLUMBING SERVICES INC
Address: zoo
City: StateFL
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT 5T LUCIE State: FL
Zip Code: Fax:
Phone No. —"-I �f5
Zip Code: 34952 Fax: 772-335-2680
E-Mail:
Phone No. 772-337-3682
Fill in fee simple Title Molder on next page ( if different
E-Mail: genesisplurnbingservices@gmail.com
State or County License: CFC1429103
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice or commencement as requirtu.
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:
Name:
Address:
City-
Zip: Phone: -
— Not Applicable
BONDING COMPANY: Not Applicable
Name- _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
IN�T.Tit�l
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 Ownec/Ee see7Contractor as Agent for Owner
STATE OF FLORIDA,,
COUNTY OF 1 7`
The forgpiwas instrument as acknowledged before me
this ayof fkCL� n 20�Uby
__.-r--( ' C--��r� -3 7
(Name of person acknowledging)
J'i
(Signature of Notary Public- State of Florida)
Personally Known :�t,R. • j Prdddk%WAGl*Rfi:iQfff Z
Type of Identificati Commission a GG 97150
+' y ommI551U X I
Commission No. """"
Revised 07/15/2014
ature of
STATE OF FLORIDA t
COUNTY OF -
The forgpi.ng instrument was acknowledged before me
this day of 1yLirL% 20 V by
(Name of person acknowledging)
{Signature of Notary Public- State of Florida) '
Personal) "'':'�
Y Known ,�a? Pr4iq¢letAtfli1dQfif
Type of Identificati ''0 d commission # GG 971 so
'-« My Commission xplre
�'s"foreaP' April Q21
Commission No.
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