HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLIBLE INFO MUSTBE C TED FOR APPLICATION TO BE ACCEPT r O�
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Date: l
SCANNED Permit Number:
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BY
St Lucie County
Building Permit Application
Planning and Development Services P �®
Building and Code Regulation Division S /0/ng °
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• 2300 Virginia Avenue, Fort Pierce FL 34982 I coup t
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Phone: (772) 462-1553 Fax: (772) 462-1578 v
Commercial I Residential X
PERMIT APPLICATION FOR: Renovation
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Address"-'Q'---
Legal Description:Oet-eS UPy-\(f t \orl. 05n d. -Sz�tiClcl� -1 9,- cc-e'1 q a0
Property Tax ID Lot No.
Site Plan Name: C4
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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1M-tc l t heL_.� OC lein,ei-,
prow► bl✓L� cl eC-64C G
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"lionalwork
to be nertormed under this permit -check all app y:
E1HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
LlJElectric ICJ Plumbing Sprinklers EDGenerator 1:1 Roof Roof pitch
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Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ (1 i 0 Utilities: Sewer ElSeptic Building Height:
Name 6d- 0 P
Name: Justin Thiery�j i
Address:9,99 LkM i 'X I LICI
Company: Island Kitchen and Bath
City: ^ 101AUY .- tLeja� State{E
Address: 10875 S. Ocean Drive
Zip Code c3��?�~ Fax:
City: Jensen Beach State: FL
Phone No. O v
Zipj Code: 34957 Fax:
E-Mail:
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page ( if different
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E-Mail: ithieryikb@gmail.com; nblaszkaikb@gmail.com
State or County License: CBC1259508
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
NGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 10875 S. Ocean Drive
City:
Zip: Phone:
E COMPANY: Not Applicable
N a m e: Justin Thiery
Address:
City: Jensen Beach State:
Zip: ! Phone:
BONDING COMPANY: Not Applicable
Name: 1
Address:
City:
Zip: I 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 authlorize 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 agreelthat I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Llucie 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 acid 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor a nt for Owner
ig t re of Contractor/License Ider
STATE OF FLORIDA
ST Ti OF FLORIDA
COUNTY OF st. L-cia
COUNTY OF sr. W ie
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The fo goiing instr w ent as acknowledged before me
this day
The for oing instr ent was acknowledge efore me
(day
of VI 20tL by
this of 20 y
Justin Thiery
Name of person maki statement
I Name of person making statement
Personally Known Produced Identification x
Personally Known x OR Produced Identification
of
Type of Identification
-Type Identification
Produced Drivers License
Produced
(Signature of N P ic- St�,t,�,�cFlorid�� LRApZ
(Signatur otary Public- a of Florida )
' • • MY OM SSION # FF 904140
otpar PVk MICHAEL RAAZ
•••'•
Commi o o. * July 28, 2019
mmissio MY COl(01811�fV # FF 904140
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EXPIRES: July 28, 2019
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F�O�\oe Bonded Thru Budget Notary Services
REVIEWS
FRONT
ZONING
SUPERVISOR
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
l
COMPLETED
g
tev. 8/2/17