HomeMy WebLinkAboutDeLoach Permit Application10162020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `�_I (i`�F� Permit Number:
Building. Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial til Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: C> (,Xe c� Q�'tt/ 3r74, <1 (Q0JU.b 10.94kAk E -L
PropertyTax ID #: lvdi- oPAQ-bc)c>--,1L4 Lot No.
Site Plan Name: t�_e Block No.
Project Name: ��2L.0l�LI•L �,OF�ioll/lc�l� 1�
DETAILED DESCRIPTION OF WORK: �, . „1 . _ . " ,,. I , -I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
_ Gas Tank
_ Gas Piping
_ Shutters
_ Windows/Doors
_ Pond
/lectric
VPlumbing
_ Sprinklers
Generator
T Roof
Pitch
Total.Sq. Ft of Construction:
Cost of Construction:$ 1a-71 5?49_Oy
Sq. Ft. of First Floor:
Utilities: —Sewer ,_Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Justin ThierV
Company: Island Kotehen & Bath
Address: 10875 S Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No 772-237-7348
E -Mail ikb.nm assistalnnmail rcm
Address: Q95b (S Qck-Aa-tL Jdf%
City: CT. 4c QU.A rf State:(
Zip Code:�`��ns_i Fax:
Phone No. qSq' :E -cl- ?5-Lz�
E -Mail:
Fill in fee si le Title Halder on next page ( if different
from the Owner listed above)
State or County License CBC12 9508
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 ail 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 vour Notice of Commencement.
Rev. 5/15/20
Signature of Owne ssee/Contractor as Agent for Owner
Signat re o Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF St Lucie
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_`� Physical Presence or Online Notarization
Physical Presence or Online Notarization
this � day of 0GTL�B�rL 2@4D by
this L day of (�'�T DI(�E /t 20t- 6y
:SC_oT i b..e_C_oa"�
Justin Thiery
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
fjL �
(Signature of Nota - State of,&jida) MICHAELRAAZ
(Signature of Notary Pub or da )
0�4
Commission # GG 3186
"' . ,,�
0 MICHAEL RAAZ
Com missi 'r )Expires July 28, 2023
al
y"�F
Com �: 1 1 k q9�rgslon # GG 318620
os 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
RECEIVED
DATE
COMPLETED
Rev. 5/15/20