HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 38 % Permit Number:
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BY
StLuele,MOW I RECEIVED
Building Permit Applicatio
Planning and Development Services JAN 0 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 5T, Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Renovation
Address: oo S oaa pr .
c0py�
Legal Description•00011 SOLI ad 6 1 I MIfi 0 U1Q 0d PEI re, 1
UM M OVI Rot � o o = z :
_ 'or
Property Tax ID#: 99 Lot No.
Site Plan Name: LeG Block No.
Project Name: _Woc
Setbacks Front Back: Right Side: Left Side:
kx" 7•
'
itiona to e e orme un' er t is permit—
c ec a apply: ❑HVAC Gas Tank Gas Pi in _ Shutters
❑ P g ❑Windows/Doors
��—
Electric L_J Plumbing Sprinklers Generator ❑Roof
_ Roof pitch
Total Sq. Ft of Constructions:S Ft. of First Floor:
/d,
Cost of Construction: $ `�' &&0' Utilities:0Sewer []Septic Building Height:
Name 6 41 "PrC/ Name: Justin Thiery
Addresss:``�� OLVA Company: Island Kitchen and Bath
City: WIAX90,0 1, State: f to Address: 10875 S. Ocean Drive
Zip Code: Fax: City: Jensen Beach State: FL
Phone No. s - Zip Code: 34957 Fax:
E-Mail: r 1, C/ - l W l v " Phone No. 772-237-7348 772-678-8219
Fill in fee simple Title 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.
1111' PZE I S WN g I I It YJA
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
commencingwork or recordingour Notice of Commencement.STATE
9—Signature
OF
Rev. 8/2/17
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:
i
Zip: Phone:
of Owner/ Lesse /Corufractor as Agent for Owner
S' natur of ntrac r/License Holder
FLORIDAC�,
11i,�-��
COUNTY OF
COUNTY OF -
The
The forgoing instru ent was acknowledge�l,before me
The fo going instr ent was acknowledged before me
��
this � day of 20 by!
this day of 201 by
col ' �
Name of person ma ing statement
Name of person Making statement
Personally Known %� OR Produced Identification
Personally Known Y— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N Public- State of Florida)
(Signature of Notary Public�St f-Floriii'a )
Com 'on No. a°';Ay Pu�`'� (5 al�1ICHAELRAAZ
FF 904140
Co ' sion No. �Y'uB`�° �,,� �ICHAELRAAZ
Ud+��IMISSION i# FF 904140
MYe CdMMISSION �
*
EXPIRES: July 28,201sEXPIRES:
Juty28,2019
RnndedhruBudgetNotaervice��tMap:
Bonded ThN Budget Notary Services
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