HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
Building Permit Application
Planning old 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:
Property Tax lD#:� F(17 CZ-- ( L' Lot No.�
Site Plan Name: _. ...
,.CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_ Electric —Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: UtilitieSq. Ft. of First Floor:
Cost of Construction:$ 2,151 s: _Sewer _Septic Building Height:_
CONTRACTOR:
Name n ✓- I.
ame: JAMES D. DAVIS _r
Address: Via(
O0
Company: JBG CARPENTRY, INC.
-�rq�
City: Q 0(�/1(, / State:Address:
Zip Code:_ _ Fax:
Phone No. yO7 -� -1C�-O L2 (1
13461 79TH CT. N.
City; WEST PALM BEACH State: FL
Zip Code: 33412 Fax: 561-8554054
Phone No 5BI-855-4 552
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License CGCO22831
_..___.._-_...,..--- w...n.c—ooem n requrrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: _
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City;
Zip: Phone:
Zip: Phone:
OWri 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 ermit holder to build the Subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 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 YOOIA LENDER OR AN ATTORNFv RFFnRF ocrnorvnn vni io Rnrec nc cnrrcu "
Signat a of Oml Bsee/Contractor as Agent for Owner
Signaturalue Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PAa tm
COUNTY OF .. ae.ca
The f oing instrument was acknowledged before me
thiszdayof HAr 2l� by
The for Ing Instrument was acknowledg before me
XdBy
this by
��3/inl/ Mr('a✓<✓p
l ESDDAW
Name of pers making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
_
Type of Identification
Produced
Produced
(Sign re of otaryP lic-Stet f Florida 11
ANGELAYOUNG
(Signet a of NPublic- of Flori
ota , t 4MEtAYOUNG
ps'
Commission No. ;:,GO9a9a61
" tZ a131
, Can a
Commission Na. A►SAP Ex �
J°
IZa0aeal
I1Z 2021
every
6awneaaWnaorrs.aw
aRl,e onautlaae,xvank..
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
FLORIDA JURAT
FS 117.05(13) — Effective January 1, 2020
State of Flodda l
county of PALM REACH Il
Sworn to (or affirmed) and subscribed before me by
means of
M Physical Presence,
—OR—
❑ Online Notarization,
this—"��dayof tin✓. 2021,by
Day Month year
JAMES D. DAVIS
�Nome
of Person S/weaannng orAffinning
Sig re of Neitary Pu a — State of Ronda
ANGELA YOUNG
Nome of Notary typed, Printed or Stamped
ANGEtAYOUNG
�'pVe 4F CommisaianXGG 968861�®��,�/ $f Personally Known
•sr'ri+d Expires AD^I 12.202d
tbFr o> 11ri,a,a„r„a, ❑Roduced Identification
Type of identification Produced:
Place Notary Seal Stamp Above
Completing this information can deter cfterotion of the document or
fraudulent reattachment of this form to on unintended document.
Description of Attached Document
Trde or Type of Document
Document Date:
Signer(s) Other Than Named Above:
02019 National Notary Association
Number of Pages: