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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ECt,z
NOV n7
Building Permit Application 2Q17
Planning and -Development Services St PERMl7-T11V(j
Lucie
Building and Code Regulation Division county, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V Residential
PERMIT APPLICATION FOR: Renovation
Address:
Legal Description: _y,ICAC�� rN 50C, i S) ra.,2jS tau h - 19042
Property Tax ID #: LI S k ( - S1 L4 - C5001,, - Q(x> - I Lot No.
Site Plan Name: 1{'q Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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6*4,6�;4/ —All
itiona work to be nertormed under this permit - check all pp y:
E1HVAC Gas Tank ❑Gas Piping Windows/Doors
_Shutters
-11ogElectric L_J Plumbing Sprinklers a Generator g Roof Roof
pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
n
Cost of Construction: $ �a, D ®d Utilities: Sewer LJ Septic Building Height:
WIN
Name
Name: Justin C. Thiery
Address: J O L41 6 S 0C,e_C) e-
Company: Island Kitchen and Bath of the Treasure Coast
City: SPA. q i3C� ea.. _ State: Ll,
Address: 10875 S. Ocean Drive
Zip Code: 3LISS'L Fax:
City: Jensen Beach State: FL
Phone No. _
Zip Code: 34957 Fax:
E-Mail:
Phone No. 772-237-7348
Fill in fee simple Title Holder on next page (if different
E-Mail: ithieryikb@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.
DESIG
x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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
befo a first inspection. If you intend to obtain financing, consult with lender or an attorney before
counmericing work or recording vour Notice of Commencement. ,
er
STATE OF FLORIDA
COUNTY OF .Sk
as
The forgoing instrument was acknowledged before me
this --I day of 20 Ljby
Holder
kTE OF FLORIDA
UNTY OF St. Lucie
The forgoing instrument was acknowledged before me
this -7 day of 20 1-) by
TeA AieA . (_t l n Justin C. Thiery
(Name of person acknowledging) (Name of person acknowledging)
Notary Pu
(Signature of Notary Public -
Personally Know /OR Produced Identification Personally
Type of I i ' n Produced Type of Inc
Commission No. (Sed4CHAELRAAZ
* JA x MY COMMISSION A FF 904140
Revised 07/15/2014
I1CA
(Seal)
MICHAEL RAAZ
MY�t9pglgr;
EXPIRES: JuIy28, 2019
Bonded Tf M Budget Nobry Senims
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS