HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Window/door
PRO POS CATION:
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Address: '1�5b 4 G�� i"t✓�L �e0 �/`s {� �`��d t ail 2`C
Legal Description: �-5( ,� C�F/X,�d✓Y� th t u�•�., T 1r6�. O� fig- �S
Property Tax ID#: too I- a I` (,e- Doo -3 Lot No.
Site Plan Name: J-DI N�w� 1 t-,�oWS Block No.
Project Name: ( A r_�X D Sk:� �k)l P,06N.J 004-
Setbacks Front Back: Right Side: Left Side:
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`7Z -..-ions wor to e e ormed under tTis permit-chec a app y:
[1HVAC Gas Tank Gas Piping _Shutters �101Windows/Doors
0 Electric 0 Plumbing O Sprinklers Generator F� Roof C� Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ �� �. Oa Utilities:cn Sewer E]Septic Building Height:
CONTRACTOR:
Name C—V Name: Justin Thiery -
Address: SJ S occ4a- _"J ,V- (a0 Company: Island Kitchen and Bath
City: State:� Address: 10875 S. Ocean Drive
Zip Code,,_1?4q�� Fax: City: Jensen Beach State:FL
Phone No. !Y i?-- b , 5Li F4 I Zip Code: 34957 Fax:
E-Mail: 104c (Q l. Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple itle Holder on next page(if different E-Mail: jthieryikb@gmail.com; nblaszkaikb@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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Nam 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
commencing work or recording our Notice of Commencement ,
Signature of Owner/Lessee/Contractor as Agent for Owner tt u4of Contractor icense Hold
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF St.Lucie
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this -day of 20e}4 by this Xclay of 6- •� 20C-:k:( by
I A � Justin Thiery
Name aAprson making statement Name of person making statement
Personally Known OR Produced Identification x Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Drivers License Produced
(S' nature of ota Public-State of FIOri�) ignature No lic-State of Florida)
Pu��c MICHAE otvPue,�c MICHA�
Commission Nor ' Commission#G130fi p Commissio o.
Expires July 28,2023 �ommisslon 8620
#, ' o� Expires July 28.2023
99 `oPo Bonded Thru Budget Notary Sarrleee 7lF oP Bonded Th u Budget No Senlces
REVIEWS FRONT ZONING ::R:EVIEW
RVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17