HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�s III
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) 462-1S78 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
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Address: �Q
Legal Description: l{�.:�.t� ��Lo f I
Property Tax ID #:�Q —�t �- DC�Z� �' ��' Lot No.
Site Plan Name: Block No. 3
Project Name: Lid ( ObOLA-D (Q '
Setbacks Front Back: Right Side: Left Side:
I ETAtI_EItiORK.
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CONSTRUCTION INFORMATION:
dTltioriai wor to e er orme un er t is permit - c ec a 'nappy:
❑_ HVAC Gas Tank Gas Piping Shutters windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: //'',,�� S Ft. of First Floor:
00 []Septic Height:
T Utilities: Sewer Building
Cost of Construction: $ ) J�L -
` OWNERJLE�E ; tu►v I ttKl I iJtt:
. II —.
Name <5hl.SeL✓\ t�1 �lYyl_Q�'1 I Name: Justin Thiery
Address: Company: Island Kitchen and Bath
City: �.Qp a-e-� State: Address: 10875 S. Ocean Drive
���1� I City: Jensen Beach State: FL
Zip Code: Fax:
Phone No.i Zip Code: 34957 Fax:
E-Mail: 5CL5 b4_((n%cxA tD nq& c-- sY`N I Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page ( if different i E-Mail: jthieryikb@gmait.com; tkjp, Pn":2Ss�S�tcA�
I 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 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, 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
comme in work or recording our Notice of Commencemen
ig atur f Owner L ssee/Contractor as Agent for Owner na re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF St. Lucie
The fo rLping instrument was acknowledged before me
this day of Q&^At.Wk 2%gL by
c, _Su-/i [ r Q ( ✓N OLPI
Name of person making statement
Personally Known OR Produced Identification x
Type of Identification
Produced Drivers License
(Signature otary Pu ' - State of Florida )
�P�°�� MICHAEL RAAZ
Com is Sea
' (Commission # GG 318620
k t Expires July 28, 2023
Q—AA Thni Budnet N7tw Services
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this day of fa_4"'4W-T_, 2001t by
Justin Thiery
Name of person making statement
Personally Known x OR Produced Identification _
Type of Identification
Produced
(Signature of_NO
Commission No.
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
(SeM)CHAEL 11AA7
Commisslon ti GG 318620
Expires J;;'y 28, 2023
SEA TURTLE I MANGROVE
REVIEW REVIEW