HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED EPTED
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RECEIVED
Date: Per it Number: )'-NltrA
MAR 0 4 2020
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®_ ST. Lucie County, Permitting RECEZ
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Planning and Development Services B 020
Building and Code Regulation Division ST. ie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door a�
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Legal Description:
Property Tax ID#: 4csC);)'- `OUa- D\C>O - OCC -D Lot No.
Site Plan Named-�G_ -f- CCJ..✓� S O Block No.
Project Name:W-- '=' ct'- ✓L_.S6 -
Setbacks Front Back: Right Side: Left Side: a
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Additionalworkto a e orme under t s permit-check
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❑HVAC Gas Tank Gas Piping _Shutters 12 Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
Cost of Construction:$ f"c�u?��' Utilities: Sewer I]Septic Building Height:
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Name Name: Justin Thiery 1
Address:'::�C:>G S OC_e 1r 4-1\C)lo Company: Island Kitchen and Bath
City:`o,y�Go_,r� oct Pkv State:rAddress: 10875 S. Ocean Drive
Zip Code: Fax:Fax: City: Jensen Beach State:FL
Phone No.�p3 I -�oo�Q -�3s4 _ Zip Code: 34957 Fax:
E-Mail: Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page Q if different E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
from the Owner listed above) I State or County License: CBC1259508
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: N am e: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 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.
Signature of wrier/Lessee/Contr or as Agent for Owner Si re of Contractor/Lic a older
STATE OF FLORIDA S ATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF St.i.ucie
The forgoing Inst ument was acknowledged before me The for oing instr ment was acknowledged before me
this y of 2 Q by this day of 2QX 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
(Signature of Notary P ic- tate of Florida) (Signature of Notary Pu ' - to of Florida)
Commission •'4•�p��•h` m, #QG31604 Commissio 0.
MICHAELRAAZnvtQmisslon#GG31
8620 vote
Expires July 28,2023
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REVIEWS FRONT ZONING -SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
Rev.8/2/17