HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ILIEL
1410111
• — Building Permit Application
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT TYPE:
Address: 4230LI RPdwncd (if ,Vart NPr( P Ick -FI4QS1
Property Tax ID#: 1�j1?j�r�;09. —OOO V-rOC'b'i Lot No. 43
Site Plan Name:Ppi DOPY c2 Block No.
Project Name:
ChQnc �oE ( � 1 Pxt�riar doou nes"�P c�lane
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: r Sq.Ft.of first Floor:
Cost of Construction:$ 4 ink w�6 Utilities: _Sewer —Septic Building Height:
Name_ Rnp11Q Zt Pn-M� Name:1AMES D.DAVIS
Address:4'3O f'pOWCM ?Jr Company:JBG CARPENTRY, INC.
city: 11cX1 Pt PI(Q State:V1_ Address:13461 79TH CT.N.
Zip Code: 5XIQ5 i Fax: City: WEST PALM BEACH State:FL
Phone No.'11-I-q'Al()JIq Zip Code: 33412 Fax: 561-855-4054
E-Mail: Phone No 561-855.4062
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,SW 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: T—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 it holder to build the subject structure
which is in conflict with any applicable Home Owners Association roles,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.Wde 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 OWPIM YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TT/IIE FOR R@ROVENE S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FRET INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
MTN YYf.ODUd/'/R LEADER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ature of Ow e/Lessee/C ractor as Agent for Owner Signature Co ctor/Ucense Holder
S TE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTYOFe -.
ThefforggpI inst ent was acknowledged before me The forgoing instrument was acknowledged before me
this(�I_'3ay/of �r 11 20-" by this3 dayof rnA IT_20 4 by
lA jC l/I� i . So.onva
Name of person making stat ent_ Name of person making statement.
Personally Known OR Produced Identifl t Personally Known x OR Produced Identification_
Type of Identification Type of Identification
Produced /L b1_ a: Produced
3 ar
(Signature of Notary Public-State of Florida I 'S € (Sign re of No Public Tate of For de)
Commission No. rt H 6 TOo 16 (Seal) 8 s F Commission No. (Seal)
e
REVIEWS FRONT ZONING S PERVISOR PLANS VEGETATION SEA TURTLE 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 1 county of PALM BEACH Jl
Sworn to(or affirmed)and subscribed before me by
means of
®Physical Presence,
—OR—
❑Online Notarization,
this cJ dayoby
f
Day Month
year Year
JAM_ ES Q. DAVIS
Name of Person Swearing orAMrtning
Sig ature of Nbtary Pub —State of Florida
ANQFLA YOUNG
Name of Notary Typed,Printed or Stamped
J?J Personalty Known
❑Produced Identification
Type of identification Produced:
Place Notary Seal Stamp Above
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: Number of Pages:
Signer(s)Other Than Named Above:
02019 National Notary Association