HomeMy WebLinkAboutBUILDING PERMIT APPAll 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 Commercial Residential X
PERMIT TYPE: DCC>K
Address: I NO2. S maNnii(Z 6 U aiT —4-u'-� —f?>'7 A
Property Tax ID #: _ 0 _,,�oa— $ooi cc)coti—ic)c:)—I Lot No.
Site Plan Name: iQTLlkI( nS)CDnboyai0lUM BLD6A i-` lT MA Block No.
Project Name: aAmt , LbF',�
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Gas Piping
_ Sprinklers
_ Shutters
zwindows/Doors
_ Generator _ Roof Pitch
Total Sq. Ft of Construction: p Sq. Ft. of First Floor:
Cost of Construction: $ 30 0� O y� Utilities: —Sewer —Septic Building Height:
NOW -
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Name LQ(Z\ A d2 1��GX1f D SCAM\,ZX
Name: JAMES D. DAVIS
Company:J&G CARPENTRY, INC.
Address: _JC)I0?_.S C)CCfAlf)-hl _U,(\%-T-1013LCCI
City: State: VL.
Address: 13461 79TH CT. N.
Zip Code: t340A `J�- Fax:
City: WEST PALM BEACH State: FL
Phone No.2q _11�
Zip Code: 33412 Fax: 561-855-4054
E-Mail:
Phone No 561-855-4052
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License CGCO22831
it vawe or construction is 57500 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
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
City:
Address:
City:
Zip: Phone:
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 YOUR PAYING
TWICE FOR VAPROVI MENTS 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.1°
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign re ofContractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
I COUNTY OF PALM BEACH
The forgoing ir,strur; 'r.t was actcr.owiedg;ad JEfG,.: n.z
The forguing instrument was acknowledged before me
this ay of // Z/ 20 2O by
this 1 h day ofDQCc2 m"CX , 20o—O by
JAMES D. DAVIS
e of person making statement.
Name of person making statement.
=Pe
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Personally Known x OR Produced Identification
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Type of identification
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nature of Notary Public- State
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DATE
RECEIVED
DATE
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FLORIDA JURAT
FS 117.05(13) — Effective January 1, 2020
State of Florida
County of PALM REACH
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Sworn to (or affirmed) and subscribed before me by
means of
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0 Online Notarization,
this l (� day of ��C • ,-2D2-0—by
Day Month Year
JAM ES D DAVIS
Name of Person Swearing orAfflrming
Si azure of N t fry Public State of Florida
AN Q vnI ING
Name of Notary Typed, Printed or Stamped
X Personally Known
CI Produced Identification
Type of Identification Produced:
OPTIONAL
Completing this information .can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
02019 National Notary Association
Number of Pages: