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
Commercial Residential x
Phone; (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address: a4C3 m�lCn CDUr
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Property TaxlDlt: 2.4�1-6f7 rJ-nO �.CI-nrn'�-
Lot No. -
Block No. lam_
Site Plan Name:
ProjectName: nl� rpsldpY\C
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1 ,n� of t l�rr�nt
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Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank
_Gas Piping _Shutters —Windom/Doom
_Electric _Plumbing
_Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 9L D� - 31
Utilities: _ Sewer _ Septic Building Height:
Name 'Tlkyom CIO.
Name: 3AMES D. DAMS
Address: at( m
Company:3&G CARPENTRY, INC.
City: Vofl Vk9rct)State:
_ Address: 13461 79TH CT. N.
Zip Code:NC(?)` Fax:
City: WEST PALM BEACH State: FL
Phone No. 3DI- U b�'-i'-bi
Zip Code: 33412 Fax:551-865-4054
E-Mail:
Phone Na 581-f1554052
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 conAmakm 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.
DESIGNE ENGINEER:
Name:
x Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:_
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
-f._ Not Applicable
BONDING COMPANY:
Name:
X Not Applicable
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 concumency 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.-
Signattiffolf Owned Lessee/Contractor as Agent for Owner
Signature of Co acto License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF —area
The forgoing instrument was acknowledged before me
The fo oing instrument was acknowledged before me
20_4 by
this_I� day o�ft,\\/fit
this`udayof AiRr•�l 20�by
r+1.
Name of perng statement.
Name of person making statement.
s�
Personally Known OR Produced Identification /\
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Pro
Produced
n re of Nota P �lic- S e of
$ '4. gpby pyMic. Slate of FlOritla
(Signat re of No ry Public- ice of Florida)-
Commission No. F C°m�r'T909110
AugaiA 29,2a2a
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Commission No. (Seal)
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REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
NeV. a/qiy
FLORIDA JURAT
P3117.0S(13) — Effective January 1, 2020
State of Flortle
County of PALM RFACCH t
Swam to (or affirmed) and subscribed before me by
means of
W Physical Presence,
—OR—
❑ Onflnne Notarization,
thisy�_day of 2021 by
Day Month Year
JAMES D DAVIS
,� ApN,ome of Person Swearing orAMrming
./ �1 —�
nature Of tmY Pu — State of Flando
Name of Notary typed, Printed or Stamped
IC Personally Known
❑ Produced Identification
Type of Ident@kabon Produced:
Place Notary Seal Stomp Above
Completing this infonnotlon 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
of Pages:
Signer(S) Other Than Named Above:
wwnara�rae
02019 National Notary Association