HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tt
Date: I QI r(/ Permit Number: 1 r V
a aVS'/
WE Building Permit Application
Planning and Development Services DEC 12 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Window/door
Address: L-1 C L) �S UCQCCtl Vi'l r,Q F I J VI IT I ooco I `lAllSQrt IJ20..CV1 t �-L c�iys"/
Legal Description:�:PS 16LII&I Ce- I 0c w4omirl lLLM 1. n I T I C)Dce
Property Tax ID a: e45-?_\,3' - coo(- 0050 -0007757
Site Plan Name:
Project Name: r C �ILVtGQ oOC (� f N pOl� �b(L
Setbacks Front Back: Right Side: Left Side:
R2PlAa L,%o rj5 S 14,i' s 5
02 Cv "LA fr _ s w ( l wip aJ:d
E1HVAC l J Gas Tank Gas Piping
0Electric 1:1Plumbing []Sprint
Total Sq. Ft of Construction: "1 �000
Cost of Construction: $
Lot No.
Block No.
)IPM
En
Shutters IJ Windows/Doors
Generator E—] Roof = Roof pitch
S Ft. of First Floor: _
Utilities:] Sewer Septic
Building Height:
Name (.l-Mir i A corn
Name: Justin Thiery
Address:(q c5 02A, _- 08-. -t Iobo
Company: Island Kitchen and Bath
City: T_WY rt putt_E_A State:
Zip Code: t{ S Fax:
Phone No.
Address: 10875 S. Ocean Drive
City; Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No.772-678-8219 - 772-237-7348
E-Mail: Ii1�. OM.0-SSIStWI{`m0.i1 •�Orl1
Fill in fee simple Title Holder on next paCgle ( if different
from the Owner listed above) ____[or
E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.(;om
State County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPlEN1ENTALGONSRUCTItN,`UEN'LQUU�NORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _
Name: Justin Thiery
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: Jensen Beach
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not
Name:
Applicable
Address: 10875S. ocean DNe
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 the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 your Notice of COmmencemertt!1
Signature of Owner/ L ee/Contractor as gent for Owner
i to of Contr t r/Lic older
STATE OF FLQ IDA
STATE OF FLORIDA
f.
COUNTY OF sr. Lu a
COUNTY OF at cede
The for oing instrument was acknowledged before me
7
The for oing instrument was acknowledged before me
T
this day of 20]fj by
this day of I>o Co nLb3-✓ , 20_a by
Justin Thiery
Name of person I ng styj ement
person
Name of person making statement
Personally Known Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Drivers License
Produced
(Signs otary Public- State of Florida)
(Signature of Farblic- Sta of Florida )
,r �� HAELRAAZ
ommission No. k'�
Co ission No. o" ? r� RAgZ
(ASmmI46,00 G318620
Coi MA nAGG318620
e' Expires July 28,2023
ya ExplreaJuly28,2023
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17