HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `% Permit Number: aaa��d3d►
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Building Permit ApplicationPlanning and.Development ServicesBuilding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 \,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Window/door--
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Legal Description�_kapj4p— rr L96(a
Property Tax ID#: '�J` c> -LQ0A- C)I 9b -C)C0 `r`i^ Lot No.
Site Plan Name: oyA (' _7 Block No.
Project Name: Loto 5 — I
Setbacks Front Back: _Right Side: Left Side:
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A : Iona work to lie Dertormed under this permit=check all apply:
HVAC Gas Tank ❑Gas PipingIJ_Shutters Windows/Doors
Electric 0 Plumbing [ISprinklers E Generator F� Roof Roof pitch
Total Sq. Ft of Construction: Sq. of First Floor:
Cost of Construction:$ �a1 clS- Utilities: []Sewer Septic Building Height:
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Name :Pj"A cec.aylt1® Name: Justin Thiery
Address: S Occan. jam, ( LLA IT (96(p Company: Island Kitchen and Bath
I City: sjgAa,t,`t ,C,�.t.pti State:J9. Address: 10875 S. Ocean Drive
Zip Code:(4LfqS z Fax: City: Jensen Beach State:FL
Phone No. l4.- T-7?y==-. _ " Zip Code: 34957 Fax:
E-Mail: (-JQ_k )r'(' IQ?(.o Cw(•Cat v-% 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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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 anti 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.
Signatur f O er/Lessee/Contractor as ftent for OwnerS'g ure o ontractor/License Holder
STATE OF FLORIDA ATE OF FLORIDA
COUNTY OF SL Lucie COUNTY OF St.Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_Lt day of 1ou�c.Rti 20�U by this Cf day of Mae,,r-,44— 20.�-Q by
�l lX V%A— Ifs 1 Z0 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 ryPublic- ate of Florida) (Signature of Notary P -State of Flo . a)
Com scion .yP MICHAEL RAAZ
#GG3i1) Commission (Seal)
N, e� Expires July 28,2r.?,3 Commisslon#GG 318620
+ oP goMudTNuBu49otNeary Ex lros July 28,2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17