HomeMy WebLinkAboutDubin Bldg Permit Application_000262All 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 Kitchell & Bath
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#:��J�- �d� -OdFs- Od 0 - Lot No.
/ Block No.
Site Plan Name: �- drA )'o
_bc.t
Project Name: IJ ( n 06'*�
DETAILED DESCRIPTION OF WORK:
Li- 'V 1 V ci__ _ c u L. - - r
tva.h � - sh n, 1 I
� r P l web �w s� 04
� �.�^•�� 9,-I ,�� sal-C�.✓ �-rTD�.s C d,;L,l �-.1t.��s , �/ �� I I� p �
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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
--E—lectric PTumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I�% �[ �� Utilities: _ Sewer _ Septic Building Height:
4
CONTRACTOR:
Name
Name: Justin Thiery
Address• �$gZ> S d e d_A L (L5
City: State: Jim
Zip Code:), Fax:
Company: Island Kitchen & Batyh
Address: 10875 S Ocean Drive
City: Jensen Beach State: FI
Phone No. �(1- r73" Gill b
Zip Code: 34957 Fax:
E-MailcLtJowi I r-r- C-tJv--,
Phone No 772-237-7348
E-Mail ikb.pm.assistant@gmail.com
Fill in fee simple Title Hol er on next page ( if different
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.
4.
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 Notic of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
gnatu of Contractor cense Hold
STATE OF FLORIDA
STAAE OF FLORIDA
COUNTY OF St- L-v—A-cam-
COUNTY OFSt Ludee
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
—Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this,_ day of 12024 by
this -4- day of , 2020 by
LA_ �)'
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 Id e tification
Produc
Produced
(S nature of N ry P isaatg� of Floril(jHAELRAAZ
ignature of y Public- State of Florida )
Commission # GG 318620
o��Y "�Bi, MICHAEL RAAZ
Commission No. * 0Uuly28,2023
Commissio . �ummisslori 620
77 �rEOpF�,OQ'� 8ondedThruBudgelNotarySenlcos
vl \o� Expires July 28,2023
FO Bonded
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