HomeMy WebLinkAboutBuilding Permit Application�V,
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 Residential X
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE
Address i C 2L�� �� '�� Q A-
.J
Property Tax ID #: Lo04-C'21 QC30"v Lot No.
Block No.
Site Plan Name:
YZ ��
Project Name:
L�ONSTRLICTION i fC3RMATION.
Additional work to be performed under this permit — check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction: �j)� 2:
Cost of Construction: $ -3--
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
__�Z Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
Name C/�_ Cpl^C
Address: -76C� ll
City: - State: i�
Zip Code: Fax:
Phone No. "Z l Z. 4?M <T� L+4 C�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: JAMES D. DAVIS
Company: J&G CARPENTRY, INC.
Address: 13461 79TH CT. N.
City: WEST PALM BEACH
Zip Code: 33412
Phone No 561-855-4052
State: FL
Fax: 561-855-4054
E-Mail
State or County License CGCO22831
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: X Not Applicable
Name:
Address:
City:
Zip: Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
tate:
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 Hcme Ow;iers 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
w�
Signature of Owner/ Lessee/C tractor as Agent for Owner Signari�of Contractor/License Holder
STATE OF FLORID44 STATE OF FLORIDA
COUNTY OF COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'day of 20�) by this i C day of 0 (IT 0 5+ , 20 ? , by
`.
{ L IBC �_,tJ', DAMES D. DAVIS
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known x OR Produced Identification
Type of Identific 'y— _ Type of Identification
Pro `�� Predated
Ignature f Nota Public- St ( nature of Notary Public- ate of Florida )
rY REBECCALEELACHANCE o0011Ugc ANGELAYOUNG
Notary Public - State of ploridn _ `' � jfon # GG 968864
V Commission No eal) Cammission#GG0824E1 C mission No. ' ExpuesApril 12 2024
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My Comm. Expires Mar 13, 202' slF P Bonded Th u Budget Notary Se vitas
REVIEWS CFRONT ZONING OUNTER REVIEW SUPERVISOR REVIEWPLANS REVI W V REVIEAVION SE REVIEW LE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED