HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /f
Date:�" Permit Number:
RECEIVED /
JAN-0$!2020
Building Permit Application
Permitting Department
Planning and Development Services St. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
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Legal Description: ��1�,.�',G4i G `��(16O Y1ly'1i� A•vv� I"t'
Property Tax ID#:0411 -o \'4PI- C>OD Lot No.
Site Pian Name: _ Block No.
Project Name: d`
Setbacks Front Back: "ght Side: Left Side:
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-Additional work toe e orme under this permit-check a appy:
Gas Tank
11HVAC DGas Piping ShuttersMW/indows/Doors
Electric Plumbing 11 Sprinklers I—J Generator LTJ Roof hoof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: _
Cost of Construction:$ C{ f `�. Utilities: _Sewer 0 Septic Building Height:
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C71'AIN�R�jLES' I~=�
Name Name: Justin Thiery
Address:'=;� S. -kit oc5 Company: Island Kitchen and Bath
City' zp'p ` Stater Address: 10875 S. Ocean Drive
Zip Code:31CN5'7- Fax: City: Jensen Beach State:FIL
Phone No.-'aa-:Z:;K�-1'x-1 G _ Zip Code: '34957 Fax:
E-Mail:�'( '_ _ _ Phone No.
772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page(if different E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
from the Owner listed above) State or County License: CBC1259508
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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LENLAUINdRMATIONSUPPLEMENTAL3
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: N am e:Justin Thiery
Address: Address:
City: State: City: Jensen Beach State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:10875 S.Ocean Drive Address:
i
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 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 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.
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Signature of Owner/Lessee/Contactor as Agent for Owner S' re Co rat License Holder
STATE OF FLORIDA S ATE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF St.i_.Ge
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this1 O day of ��j�20h by this day of�P Tp �kja— .20 by
Justin Thiery
Name of person making sta ent 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 Pub' -State of Florida ) (Signature of N ary Public-Stat f Florida)
Sea Commission No. �otrt<.vge MICHAEL
Commi o. Wd iw ( MICHAEL RAAZ i Comm183100#GG 1 20
Commission#GG 318620
Expires July 28, 0
Expires Jul28,2023 'fForF�oQ� BondedUnisudgetNora es
pp�o Battled BudgetNolerySerfto
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED _
DATE
COMPLETED
Rev.8/2/17
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