HomeMy WebLinkAbout8900 Champions WaySUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:_
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Haaress:
City:
Zip: Phone:
State
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: —
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attornpw hofnro
VV01rc of re-curding your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
gnature of Contractor Lic.ens
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OFsTLUCIE
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before
Physical Presence or Online Notarization
this day of
me of
x Physical Presence or Online Notarization
2020 by
this-044401L� day of _?, tiC . 2024 by
Name of person making statement.
BARBARA J LOPEZ
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Personally Known x OR Produced Identification
Produced
Type of Identification
P oduced ,g
(Signature of Notary Public- State of Florida)
(Signature of Notary Publie.�da )
Commission No. (Seal)
o,%txypua�i BARBARAJ.lOPE2
Commission No. HH099764 "'••
* Va I Pommission N HH 099-1
mf Expires April 24, 202
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bonded 9j oP� boed Thtu &miW WUry SF
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW
DATE
REVIEW REVIEW REVIEW REVIEW
-
RECEIVED
DATE'
COMPLETED
Rev. 5
All 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) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential X
PROPOSED IMPROVEMENT LOCATION:
Address: 2g60 ep,�� y'�' !t4
Property Tax ID #: .? 33 Y - -5--a / - o0 76o - fto - y Lot No.
Site Plan Name: G4t_f 1A Ax Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ec C'-,K S 54, S "'-*t- /, Ac- aCiP !, h E
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ g 0 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _ .41-4/, kpd
Name: JOSEPH F TULLY
Address: gf Op Gf�i�t,.,,o,�..,.5 y
Company:GENESIS PLUMBING SERVICES INC
City: D�-f 1.�;.�¢ Guy, t State:
Zip Code: Fax:
Phone No._7 /Y 683 OD Y
Address: 1532 SE VILLAGE GREEN DRIVE UNIT B
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax:
Phone No 772-337-3682
E-Mail: C,44-QA /y y,2 C-v gg%&y C_a,,...,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail GENESISPLUMBINGOFFICE@GMAIL.COM
State or County License CFC1429103
.. v-..a I U%.L U11 W L7UU UI mere, a mtt-uKuru rvotice oT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.