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 Kitchell & Bath
Address:
0
Property Tax ID #: PU 1C> d6C> — Lot No.
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
dllo--h 6Y1
Block No.
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:
Cost of Construction: $ C�o
Sq. Ft. of First Floor:
Utilities: __ Sewer _ Septic Building Height:
N am e L)ld,&J 1° T- b c,�
Address:QSSa SU�Csa.I� Lw I "L4- ZD
City: "31k h-3. ¢ ll .�e.� Stater
Zip Code: r3 4g75' Fax:
Phone No. T(J-- SLf3-- )-((
E- M a i 1: -1 JDJ 61 A � � .. � c la_ r An
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Justin Thiery
Company: Island Kitchen & Batyh
Address: 10875 S Ocean Drive
City: Jensen Beach
Zip Code: 34957 Fax: _
Phone No 772-237-7348
E-Mail ikb.pm.assistant@gmail.com
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.
State: FI
DESIGNER/ENGINEER:
Name:_
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not App
State
e MORTGAGE COMPANY:
Name:
_ Address:
City:
Zip: Phone:
— Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Not Applicable
UWNtK/ (.UN I KAL I UK 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 r ules, 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 attornev before commencing work or recording our Notice of Commencement
Signature of er Lessee/Contractor as Agent for Owner
Si atur of Contractor/License H otr
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sr Lt'L_�
COUNTY OF StLuciee
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_je_ Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this 1�tr� day of 0o aAu_ AAa , 2021 by
this Lu day of rWgA4pav- - 2021 by
Justin Thiery
Name of person rf4king 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 Notary Pu a f Florida)
ota lic- to of Florida)
(Signature o:0.
0'gky IN', MICHAEL RAAZ
a ,...., c
Commission *(StE*misslon#GG318620
(Seal)
�, or Explres July 28, 2023
%Commission yr MICHAELRAAZ
'1C3 ...' /'
e oP
Commisslon # GG 318620
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
o= Axpires
SEA` LE Bond
July 28, 2023
W F"p tiiRQktErvice
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. blb/W