HomeMy WebLinkAboutBuilding Permit Application Sep 01 1508:37a Genesis Plumbing Services 772-335-2680 p.1
ALL APPLICABLE INFO MUST BE COMPLETED I OR APPLICATION TO BE ACCEPTED
1 k$ Permit Number:
- ' R ECEIV";D SEP 012015
Build ng 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 — q ��
f-
ORO POSED!IMPROVEMENT LOCATIO :
Address: Se AJ t9l �
Legal Description: .-v Pfi 2K U k�LIC �S LOT- 1(4
Property Tax I D#: �y rJ 3 a d d 0 Lot No.
Site Plan Name: Block No. �5
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e Orme under isI ermit-check all thal appy:
HVAC Gas TankasPiping Shutters Windows/Doors
EjElectric _Plumbing prinklers F]Generator EJ Roof
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ 5 Utilities:1:1Sewer O Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name 6S Name: ':3Q5 f P ff IUr.L`/
Address: qV Sr- A4 QA/V Ill/ Company: &ON Fg�s AwwatN6 �RU���•
City: �o T 5-r {.uc c #ate:.2q - Addre�sss: /q02 .S, Boc fd� Avis
Zip Code:,��QS3 Fax: City: 1-v�'r S-T state:
Phone No. `?72- 97L(lin Zip Code: 3��tS"Z Fax: .
E-Mail: Phone No. `772"5-?7 -340
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed.above) State or County License: ((fe
If value of construction is$2500 or more,a RECOA 3ED Notice of Commencement is required.
Sep 01 15 08:37a Genesis Plumbing Services 772-335-2680 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: —Not Appl cable MORTGAGE COMPANY: _Not Applicable
Name; Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Appl cable 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 gra ting a permit will authorize the permit holder to build the subject structure
which is ir.conflict with any applicable Home Owner Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners As ociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested pei mit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Ujilding Codes and St. Lucie County Amendments.
The following building permit applications are exemlit 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 Recorii a Notice of Commencement may result in your paying twice for
improvementsto your property. A Notice ol 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 our Notice of Commencement.
`- s
ig—nature of Owner/Lessee/Agent " nature of Contractor/License Hol
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before ine The forgoing instrument was acknowledged before me
this_day of 20 _by this_day of 20 _by
(Name of r on cknowle } (Name of rs n ack wl ing)
QHhhiliMl
(S" nature u {d2d19 ignature of •lic- ay >�•2418
' y' Wvr04+�p ,SC/r 91;'51 lu Naa
Personally entr icati n ZPersonally KnIQ
ation Produced of Identifi on Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS