HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datc: PermitNumber. __
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
PERMITTYPE: C'Lo� I —
Additional Address: 9895 S fnibiArl iZAVE(LbrZilC—
Property Tax ID n: 3525) - 223-C-Cx02 - CCC) -2 Lot No.
Site Plan Name: o,CI —3�a —4I Block No.
Project Name: `I�AVIC`t 4nrY�F r�iT work to be performed under this permit -check all that apply: !'
_Mechanical _ Gas Tank �w_ Gas Piping _ Shutters indowVDo _ors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Z Sq. Ft. of First Floor:
Cost of Construction: $ CJ�I Z➢Z-{(� Utilities: _ Sewer _ Septic Building Height:
NamerAAyu ICI I�Name: JAMES D. DAVIS
Address:9ig55lr1bl Rrl 21VE2n2 57Orn Company:3gG CARPENTRY, INC.
City: PT P1E(1CG StateFC- Address: 1346179TH CT. N.
Zip Code: 34 �8'� Fax: City: WEST PALM BEACH State: FL
Phone No. Zip Code: 33412 Fax: 501-8554064
E-Mail: Phone No 561-8554052
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License CGCO22831
N 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 Commencemerd is required.
a Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Address: I Address: —
City: State: _ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIOVIT: 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 concurrenry, 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 NPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST RE RECORDED AM
POSTED ON THE JOB SITE BEFORE THE FEW INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, COMSAT
.WITH YOUR LENDER 0" ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of ner/lessee/C twas Agent for Owner
Signatu of Contractor/License Holder
STATE OF FLORIDA? \
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STATE OF FLORIDA
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The forgoing instrument was acknowledged before me
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this�dayof .20�by
this day of JQ ✓1- .201 by
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Name of person making statement.
Name of person making statement.
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Personally Known OR Produced Identification _
Personally Known a OR Produced Identification
Type of Identification
Type of Identification
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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nev. c/r/iy
PLORIDA JURAT
FS 117.05(13) — Effective January i, 2020
State of Flonda 1
county of PAI M RFAC,,H11
Sworn to (or affirmed) and subscribed before me 6y
means of
Z Physical Presence,
—OR—
❑ Online � Notarization.
this NIs.�_tlayof L v) ,by
Day Month year
—JAMES D DAVI
Nome of Person S"Gring orAMonfrq
Sighowre of NO Publk — State OCFlorldo
ANCIE A VOI ING
Nome O)Notory typed, Primed or Stomped
M Personally Known
❑ Produced Identification
Type of Identification Produced:
Place Notary Seal Stomp Above
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Completing this inforrnadon can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
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02019 National Notary Association