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All 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 Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: DOOR REPLACEMENT
Address: 8848 FIRST TEE RD
Property Tax ID g: 3334-500-0070-000-1
Lot No. 59
Site Plan Name:
Block No.
Project Name: TERMINI, M
CHANGE OUT SIDE DOOR, NO SIZE CHANGE.
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutter _Windows/Doors
_Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4.458.89 Utilities: _ Sewer _ Septic Building Height:
Name MICHAELTERMINI Name: JAMES D.DAVIS
Address: 8848 FIRST TEE RD Company: J&G CARPENTRY INC
Cm,. PORT ST LUCIE State: _ Address: 13461 79TH CT N
Zip Code: 34986 Fax: City: WEST PALM BEACH
State: FL
Phone No.681.758.2427 Zip Code: 33412 Fax:
E-Mall: Phone No 561-8554052
Fill in fee simple Title Holder on next page ( if different E-Mailiub[cta(R%70 , t®rn
o
from the Owner listed above) State or County License CGC 022831
Ifvalue of wnstruction is 2S0o or more, a RECORDED Notice of Commencement is required.
N value of HAVC Is $7,501), or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: _ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 Counttyy 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 antl 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
ender or an attorney before commencing work or recording our Notice of Commencement
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Signature f caner/Lessee/Contractor as Agent tor Owner
Signature ofC Ir or/Ucense Holder
STATE OF FLORIDA (
STATE OF FL�RIDA
COUNTY OF �- l.(/LC
COUNTY OF YP1m bC'aCl.
Swo to (or affirmed) and subscribed before me of
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this � day of Dew 20201 by
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Name of person making statement. /
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DATE
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DATE
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FLORM JURAT
FS 117.0r(13) — Effective January 1, 2020
State of Flonda
County of PALM BFACH
Sworn to (or affirmed) and subscribed before me by
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Type of Identification Produced:
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Comp/eang this infirmation con defer alteration of the document or
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Description of Attached Document
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D=ment Date:
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Number of Pages:
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02019 Natlonel Notary Association