HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PROPOSED IMPROVEMENT_ LOCATION;
Address:
Property Tax ID #: �a— (�Ql— Q r% ��p —Al Lot No.
Site Plan Name: T G�.Q Block No.
Project Name:S
DETAILED DESCRIPTION OF WORK;
r.
New Electrical Meter Second Electrical Meter
1—CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
electric —5-viumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:^ Sq. Ft. of First Floor:
Cost of Construction: $ Oy Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 4 l
Name: Justin Thiery
Address: g ZJCCit/L"
Company: Island Kitchen & Batyh
City: t/ //t�Pie �a State:
Zip Code: C Fax:
Address: 10875 S Ocean Drive
City: Jensen Beach State: FI
Phone No.
Zip Code: 34957 Fax:
E Mail: /!h llass5af_LL/Nl Qga�tQ. C4-)*-'
Phone No 772-237-7348
Fill in fee simple Title Holder on next page ( if different
E-Mail ikb.pm.assistant@gmail.com
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.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
�004A
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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 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 our Notice of Cornmencement.
A /"-, I /
Signature of ner/ Lessee/Contra for as Agent for Owner
Si a ure f Contractor/N older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF "n�T L sue•
COUNTY OF 8t Ludee
Sworn to (or affirmed) and subscribed before me of
Physical Presence
Sworn to (or affirmed) and subscribed before me of
or Online Notarization
this day of (Tc4.ti.L 2021 by
x Physical Presence or Online Notarization
this�day of 2021 by
Justin Thiery
Name of person maLgg 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 of ry, bl' StT o
oMMISslo 966
(Si atur Ar n9>f(F ��
Commission NcTF o� ExplresJuly28, � 1�
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onuea I"IUD udget Nota err Cos
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Commission 9444DFFto 8ondnerna,a,w Seal
et Notary
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