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ALL APPLICABLE'INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: � (9 6
RECEIVED
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Building Permit Application ',JAN 0 3.2020
Planning and Development Services
'Permitting Department: i
Building and Code Regulation Division St.Lucie co!mty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X j
PERMIT APPLICATION FOR: Window/door �
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PROPOSED f1ViPROUEME.NTO 0%`�IaN '
INTO r E Zi � 44 r^ r j„i>F t.�£'.,_ L•_ �*F5, d..z?'k" `7 _ .,,�'s xs
Address:q�_ C)Q Q a'n 2)P-A-
Legal Description: ���(1�1�i G 1 L1�1r�G�C�1M�v�►�..►-�r� 1��t �C� P
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Property Tax ID#AF50a (OOG I - DUIv6 OOo Lot No.
Site Plan Name�,,t��$ 1G"�1/(�.Y1�'G—C O Block No.
Project Name: (J�'��' 1�(i�-✓�CG�U I
Setbacks Front Back: Right Side: Left Side:
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QTAILD DECRIP I�ONdOE# ORCs �
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CNSTRUCTIE�N [NFO 41TIC�R _
Additionalwor to be nertormed under thispermit—checl affapplhutt,:FiVAC Gas Tank r—iGas Piping ers Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: y S Ft. of First Floor:
Cost of Construction:$ J ci,3.5 Utilities:'n Sewer Septic Building Height:
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Name_O rY-A r ' Name: Justin Thiery
Addrss:C—�Cp S. Q'��G.r -) Dr l/�Vl�-I Company:an Island Kitchen and Bath
City: y-S ell State: Address: 10875 S. Ocean Drive
Zip Code3A�S__± Fax: City: Jensen Beach State:FL
Phone No ��_9l — el 4 14 _ 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
I If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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S'U PLEMEN,T�AL CON-i'T
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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:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:10875 S.Ocean Drive 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 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 ofthe 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 j
commencing work or recordin r Notice of Commencement.
ignature of Owner/Lessee/Contractor as Agent for Owner Si o Contractor icense H er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SL Lucie COUNTY OF St.L.Ge
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of tie-,5 20 (`l by this day of 20n by
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
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(Signature of blit-State of Florida) (Signature of ary Publi ate of Florida)
Com s ' o. 1'+►Ywc� (SAJtlQHAELRAAZ Co is ' o. ynYro& (Seal)AICHAELRAAZ
Commission#GG 318620 + * Commissloo#GG 318620
N� N` Expires July 28,2023 Nr o� Expires July 28,2023
FL OM-40
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17