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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ O\ \011 �\ Permit Number:
OCT d ?�"
Building Permit Application sr, lucre County, Permitting
Planning and Development Services 9
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: Renovation - c c,,,,Ya
Ad
Legal Description:
Property Tax ID #: qU3 -c0 Li3-CCU - `f Lot No.
Site Plan Name: 1,� 1 I�r SCIr, r✓ irJG Block No.
Project Nameknv 1 k k11- SCy\ or►r-i (D C,
Setbacks Front Back: Right Side: Left Side:
PMHVAC L��=J��//Gas Tank
Electric Erpiumbing
unaer tnrs permit - cl
[]Gas Piping
Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
an apply:
_ Shutters
Generator
Sq.
of First Floor: _
Utilities:0Sewer Septic
aWindows/Doors
Roof Roof pitch
Building Height:
$i
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Name
Q
Name: Justin Thiery
Addr ss:cl CI���U Gecc.
�� 1002
Company: Island Kitchen and Bath
Cityi V`SQ V,) kj %I
State: 93-
Address: 10875 S. Ocean Drive
Zip Code: -�- Fax:
City: ,Jensen Beach State: FL
Phone N(6Io
Zip Code: 34957 Fax:
E-Mail:_15GIn',rri o rJrCCr�\Cr\e,
r�r-r
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page ( if different
E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
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.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
N am e : Justin Thiery
Address:
Address:
City:
State:
City: Jensen Beach State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
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,
�Sighatuo of Owner/ Lessee/Contractor as A nt for Owner
Si atur trac r/License Holder
STATE OF FLORIDA
E O IDA
COUNTY OF St. LUC1B
COUNTY OF St. LuGe
The forgoing instr, ment was acknowledge efore me
this 1 day of 20 � by
The fp oing instr ment was acknowledged before me .
this II day of. A20_JA by
Justin Thiery
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identific
Produced Drl icense
Produced
(Signatur of Notary iate of MWASL)RgpZ
(' nature o otary Publi Flori
.r * commfaelon # 00 3160
r * Comml!llon # 00 918820
Commission No. Explrel, 1➢29,2023
Commission No. • 28,2023
OFF >loMedfhrugix ( y
No1a�6erYbeo
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17