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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dato
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 fax: (772) 462-157$ Commercial Residential x
Address: [Q �- ---
Property Tax ID #f: 01 `� 3 �d a _ Lot No. -I La
Site Plan Name: r 1' Block No. 3_
Pro}ect Name:
Additional work to be performed under this permit - cheek all that apply:
Mechanical ! Gas Tank _ Gas Piping
Electric — Plumbing _ Sprinklers
r.tys Sq. Ft of Construction: �� + 0119
Cost of Construction: $
Name L5 Dc- r to r-r ..5
Address: 54, r c et
City: �f Q. rc:'- State:
Zip Code: 3'-t 4`T Fax:
Phone No. Q
E-Mail:
shutters Windows/Doors
Generator , Roof Pitch
So. Ft. cf First Floor: _ -
Utilities: Sewer Septic Building Height:
Fill in fee simple Title Holder on next page (if different
from the Owner fisted above)
Name: JAMES D. DAVIS
Company:J&G CARPENTRY, INC.
Address: 13461 79TH CT, N-
City: WEST PALM BEACH State: FL
Zip Code: 33412 Fax: 561-855-4054
Phone No 561-855-4052
State or County License GGCO22831
L—
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
Name:_
Address:
City:
Zip:
NGINEER: x Not Applicable MORTGAGE COMPANY:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City:
Zip:
Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
!Name:_
Address:
City:_
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 Corpnty males no represe►:tation that is granting o pe mit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or aria 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."
j _ 4l�sLi
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Signature ofOwner/ Lessee/Contractor as Agent for owner Signature of C ntra or/License Holder
STATE OF FLORIDA •
COUNTY OF
The or ping instrument was acknowledge ,before me
this �- day of 2 by
Name of person rrMking statement.
Personally Known OR Produced Identification
Type of IdentificatioFL Driver License
Produced h,siraf presence
r`1
STATE OF FLORIDA
COUNTYOF --B cw
The forgoing instrument was acknowledged before me
this - day of Jy n, 20_!�A% by
JAMES 0. DAVIS
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
t ature of Notary Publi
�OSA 3AR_:A5
tSignature of Notary Public- State 0 ��ida j RITASALI�O
# Gi3289560
Commissiongsvon
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fFlorida:
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Commission No. r t
Camnrlanlvn
t5yes January 12, 2fl23
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REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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