HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj!)
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Permit Number:
Building Permit Application
Commercial Residential x
Property Tax ID #: �1L1 lC� C�C1�7 ❑ )'q� _ Lot No.
Block No.
Site Plan Name: ,
Project Name:
r Vyl Yl[lkp
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:
Cost of Construction: $ _ I61
NameCN KISYn PtiL-R G � PLIERS C
Sq. Ft. of First Floor:
'Jtilities: —Sewer —septic Building Height:
Address: k 4 4 S
City: Pc-kT C� T State: fz--
Zip Cade: NqC t Fax:
Phone No. �- 4
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed 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
F-Mail
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 mare, a RECORDED Notice of Commencement is required.
x Not APPIICaDIe 1 MORTGAGE COMPANY: r. Not Applicable
Address: Address:
City: State:_ City: State: _
Zip: Phone Zip: Phone:
FEESIMPLETITLE HOLDER: Not Applicable ICBOdNDING COMPANY: Not Applicable
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 Counttyv permit
makes no representation that is granting a pert 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 N YOUR PAYING
TWICE FOR NPROYE ENTS 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
TYRO YOUR LENDER AR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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gA'ure of er/Lessee/Contractor as Agent for Owner
Signature of tr or/Ucense Holder
ATE OF FLORIDA
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STATE OF FLORIDA
COUNTYOF �I.
COUNTY OFw.usarwcn
TheI sing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this7rdayof%� 20T� by
this " dayof AOC US t- .2021 by
v1�'g' JLrU 3GN
LAMES O. DAVIS
Name of person making statement.
Name of person making statement.
Personally Known _OR Produced Identification 2sr
Personally Known x OR Produced Identification
Type of Identcaj�on
X
Type of Identification
Produced J}Y{Y , b'em7L
Produced
sign u of NotaryPu ic- State of Florida)
(Signature of Notary Public, State
ROBERT RIE
Commission No. ,sFs (e I)NONry pubs, State o
FWptla ssion No. (Seal)
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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FLOPJDA JURAT
FS 117.0503) — Effective January 1, 2020 -
State of Flonda 1
County of PAIPAI MM RFAQH_ 11
Swam to (or affirmed) and suburiixd before me by
means of
(A Physical Presence,
—OR-
0 Online Notarization,
this _I_dayof AU Cs LLS202t by
Day A*WM Year
JAMU D DAVI
Nome ofParsyn Sweanrg orAfirming
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ANQ 1 A Y01 IN
Nome OfNOtory Typed, Printed wStampad
10 Personally Known
❑ Produced Idehtmcation
TyPe of Identificadon Produced:
Place Notary Sao/ Stamp Above
OPTIONAL
Completing this information can deter alteration of the document w
fraudulent reattachment of this than to an unintended document
Dascriptlon of Attached Document
TIUe or Type of Documem:
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Signer(s) Other Than Named Above:
02019 National Notary Association