HomeMy WebLinkAboutBuilding Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
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: Renovation
PROPOSED IMPROVEMENT LOCATION:
Address: L jtr�jb 4I�,L V -e_ (,L{t lT (LfoG i �� �l�k�L I��,/C�Ac C. 6Y,isz
t
Legal Description: LAtI LT (LOO(o
Property Tax ID #: ' t �c",t-• (ro Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:— Right Side: _ Left Side:
U T; LE1 UESCRIR 1 .N CIF ORIC
�n er
Addl Ional work o be nertormed uncler triis permit — crieck all Wat appy:
HVAC _ Gas Tank E]Gas Piping _ Shutters Windows/Doors
Electric L=J Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��S (9�a ^ _ Utilities: Sewer Septic Building Height:
R�tCTUR:
Name At S b1 (_�—_01'0
Name: Justin Thiery
Company: Island Kitchen and Bath
Address: S i 1:�-' (LAp
City: • State: L-�P—
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 5_Fax:
Phone No.
Zip Code: 34957 Fax:
E -Mail: rA h LSA \ 9► &30✓1-3 QM &jl • �- ! Nl,
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page ( if different
E -Mail: ithieryikb@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.
DESIG
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
N am e: Justin Thiery
Address:
City: Jensen Beach State: _
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
STATE OF FLORIDA
Name:
Address: 10875 S. Ocean Drive
COUNTY OF St. Lum
Address:
City:
this-- day of 20�by
City:
Zip: Phone:
Justin Thiery
Zip: Phone:
Not Applicable
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 record' our Notice of Commencem
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat e o Con ractor/Lice a Holder
STATE OF FLORIDA
S TE OF FLORIDA
COUNTY OF St. Lucie
COUNTY OF St. Lum
The fQrgging instrum nt was acknowledged before me
The for Ding instrument was acknowledged before me
this 9 day of 20� by
this-- day of 20�by
]MON N � r ( Lg
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 Pu a of Florida)
(Signature o ry Public- St of Florida )
Commissioner (Seal)
�pR MICHAEL RAAZ
C mission__(S�i�nmlaslon#GG 31862
Pgge MICHAEL RAAZ
V'N0"e.,
x,91
Commlaslon. GG318620
Expires July 28, 2023
o.oma Sanded Thfu Budget Nota sere
REVIEWS
FRONT r'F
DP4NGBended
L tRVISORB
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17