HomeMy WebLinkAboutBuilding Permit Application • �. ��� SCAfQ 3 ZI
All APPLICABLE INFO MUST(BE COMPLETED FOR APPLICATION TO BE ACCEPTED h�
Date: -5. �1 Permit Number: DA V-'—m
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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: W•�h��� add
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Address: ?q L( 5 00'7nn- CY V Q (' PT 60E)
Property Tax IDS#: W�09- - 5. Lot No.
Site Plan Name: Block No.
Project Name: Y'0'pY-\ib 12p5�0PYkcQ
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters -4- Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ I b 00 .?55 Utilities: _Sewer i Septic Building Height:
Name 1 y&n to PY1iC� Name:JAMES D. DAVIS
Address: ; l,)f,)qQ 5 QC.fCX� 01-• DpJ bDb Company:J&G CARPENTRY, INC.
City: p.YYl ���.� State:Y 1 Address:13461 79TH CT. N.
Zip Code: '�)t�q5 Fax: City: WEST PALM BEACH State:FL
Phone No. Zip Code: 33412 Fax: 561-855-4054
E-Mail: r-`' 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
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.
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IN 111
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: — NofiApplicable
- Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: )C Not Applicable BONDING COMPANY: --/Not Applicable
Name: Name:
Address: Address:
City: 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 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."
Signature o ner/ a ee/Co rac o as Agent for Owner Signa ure�of Contractor/License Holder
STATE OF LORIDAI _ STATE OF FLORIDA
COUNTY OF �MQVC1 NU COUNTY OF PALM BEACH
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this�day of uV APP 204 by this ( day of t`�C`C)� .20 a k by
AY ` C ,0 K JAMES D.DAVIS
Name of erson making statement. Name of person making statement.
Personally Known OR Produced Identification N/ Personally Known x OR Produced Identification
Type of Identification �� ��` "�J�7-0 Type of Identification
Produced 4k, 0L �� 'f Produced
(Signatu a of ary Public i n ure of N to Publi State of ida
���� po Notary Public State of Florida g ry ocr �a�e�� ANGELAYOUNG
Commission No. ®`; age Staples
x missionGG235102 mmission No. * f$eimission#GG9S886
Expires O'710412022 `� T4 "'Q
9'�'==' �a xpiros April 12,2024
of fL� l O F o� Bonded Thru Budget Notary Servic s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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