HomeMy WebLinkAboutCrowell Permit Application_000185All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9-1ro LCUC—N
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Island Kitchen & Bath
PROPOSEDIMPROVEMENT LOCATION:
y
Address: ✓e
Property Tax ID #: X44_5b'! -' Lot No.
Site Plan Name: lam' Block No.
Project Name:
w.
L-
w �I +-LA � .e n carrV t6 -a
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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �Z{�t d� Utilities: -Sewer _ Septic Building Height: _
CONTRACTOR:
Name CrJ
Name: Justin Thiery
Address: J b S (��GQ4-� � 17
Company: Island Kitchen & Batyh
City: tI'2��State: e(,-
Address: 10875 S Ocean Drive
City: Jensen Beach State. FI
Zip Code: cJ`-t`2Sr% Fax:
Phone No. �iv�i� 4�'Jd��'`ty
Zip Code: 34957 Fax:
E-Mail: )rS 04rn&J _
Phone No 772-237-7348
Fill in fee simple Title Holder on next page ( if different
E-Mail ikb.pm.assistant@gmail.com
State or County License CBC1259508
from the Owner listed above)
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
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, 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 inspec .on. If you intend to obtain financing, consult
with lender or an attorney before commencing work or rec ing your Notice of Commencement.
1�1_ aj
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Signature of Owner/ essee/Contractor as Agent for Owner
atur of Contractor/Lice se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5T ,
COUNTY OF StLuciee
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and
subscribed before me of
P ysical Presen or Online Notarization
Al 202V by
X Ph sical Presence or Online Notarization
this day 2020 by
this day of
of
e,*" t C _ A dlu- JJ
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
(Sign ture of otar blic at ip�do rids) MICHAELRAAZ
(Sig ature of
State q flq{ida) MICHAELRAAZ
Commission # GG 318620
No. (Sea6piresJuly28,2023
,0u6-
Commission No.
` ' ° Commission # GG 318r,
ly 2
Yo Sea�pleu8,2UCommission
�rFafR�pa\ Bonded ihruBudget NoteryServbeb
~lFOF(�oQ� BondedTnruBudgetN.'try`
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20