HomeMy WebLinkAboutBuilding Permit Application . i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: 91,
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Building Permit Application's?/een9
Planning and Development Services G�o�e�epdrt
Building and Code Regulation.Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
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Address:(- ��7`�U S. �GPr^r-� �r l/tX�t-' 10C'15 ,.I[7�&,nk-2
Legal Description: looks f,aI i^ ( l cAnCbr -N IV--,, ,r,.. U41-11 6C)s
Property Tax ID#Ae�Q�-- U I -G 04,C1 -d OG Lot No.
Site Plan Name: rYIC C01�r�� Block No.
I Project Name: - AA-M Gcayn -ve-U
Setbacks Front Back: Right Side: Left Side:
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Additional wor tobenertormed under this permit-check all appy: !4
I_IHVAC _Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑_Plumbing ,Sprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction: _ S . Ft. of First Floor:
Cost of Construction:$��`��COC� . - Utilities. Sewer Septic Building Height:
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Name��}- Accor �r�_I ( Name: Justin Thiery
Address���' O S. 0GeG-tom �_ �D _ Company: Island Kitchen and Bath
city% kA2QQen State:fF- Address: 1'0875 S. Ocean Drive j
Zip Code:i34C1.S�- Fax: City: Jensen Beach State:FL
Phone No.-"-i;�-�3� -�34g M Zip Code: 34957 _ Fax:
E-Mail: O -� I Phone No.'772-678-8219 - 772-237-7348
Fill in fe imple Title Holder next page(if different E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com'
from the Owner listed above) State or County License: CBC1259508 —� I
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:Justin Thiery
Address: Address:
City: State: City: Jensen Beach State:
Zip: Phone Zip: Phone: II
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable"
Name: Name:
Address:10875 S.Ocean Drive Address: I
City: City: I
Zip: Phone: Zip: Phone: J
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 thepermit 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.
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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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature—of Owner/Lessee/Contractor as Agent wner Sig ature o nt or/License Holder
STATE OF FLORIDA TE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF St.Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ' \day ofl�ePc1 eh,= 20 Ict by this4L day of � ,t, . ,20—n by
a,.—F Justin Thiery
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification x Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Drivers License Produced
(Signature of Nota -State of Florida) (Signature of Not ic- ate of Florida)
Commi n o1�;�r, (seal)MICHAELRAAZ �rnvr MICHAEL
C ission'No. °.�••' �al)Commission#GG 316
commission#0131318620 31
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Expires July 28,2023 y, Pow Expires July 28,2C 2
Bonded Thru Budget Notary!a es
VFPI
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER ' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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