HomeMy WebLinkAboutWest Permit_000011All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '[lap Permit Number:
Building. Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division Commercial ,D Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
��
Name:PROPOSED IMPROVEMENT LOCATION:
Site Plan I
Block•
Project Name►J�
DETAILED DESCRIPTION OF • '
.IV _ - - . •� _I=/ . ,, a", . =PERRIN
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
Electric LxPlumbing Sprinklers _ Generator Roof Pitch
Total.Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _91 (0-70N oog Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �'
Addr ss:5�C� <". � n,r i 0C1
City..Q w\& I V\ State:
Zip Coder� Fax:
Phone No.Ack -\0�(� - 41i,
E-Mail: —
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Justin Thiery
_ Company: Island itchen P.Bath
Address: 10875 S Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No 772-237-7348
E-Mail ikb.pm.assistant gmail(-nm
State or County License CBC1259508
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:_
Address:
City: _
Zip:
Phon
MORTGAGE COMPANY: i Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 permit 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, wails, 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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sigr t e of Contractor/ "tense Holder
STATE OF FL0�.� IDq
STATE OF FLORIDA
COUNTY OF �C" l�AM
COUNTY OF St Lucie
Sworn to (or affirmed) and subscribed before me of
Sw� to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 20al by
this day of 200 U by
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
(Signature ota Public- State of Florida
(Signature2ofNot ublic- S t of Florida� )1�'OtY
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Expires July 28, 2023
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