HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �.-�
Date: Permit Number: /ST)- 0 0o11V
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Building Permit Application BY
Planning and Development Services St. Lucie County
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: Building c>,jCZ t: CV)
PROP,OSED'IMPROVEfVIENTW..CATION:�, , ; -
Address: I I -
Legal Description:
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
;DETAIy. LE-'D°DESCRIPTION OF WORK �.,, "
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l y- �gqg—1- nC oc,&A ee e-7&49W
CONSTRUCTION:INFORMATIONi�r >
Additional work to be performed under tis permit —check all apply:
11HVAC Gas Tank Gas Piping _ Shutters ❑ Windows%Doors
171 11 Electric 0 Plumbing ❑Sprinklers ElGenerator Roof
Total Sq. Ft of Constructions/ ScFt. of First Floor:
4 Cost of Construction: $ 4,560 Utilities. Sewer DSeptic Building Height:
OWNER%LESSEE:; " •: '
.._ , .
CONTRACTOR -
Name 9-6 i ->'- I 4,nyJAard .Anna L S}ar tt
Name: Justin Thiery
Address: ( i'q- Ocrnig F3 t&- L7l
Company: Island Kitchen & Bath
City: �J ?�—C2017 V State: FL
Zip Code: 73qcl 5r;r- Fax:
Phone No. 4� 34 l— 54`L--
Address: 2340 SE Charleston Dr.
City: Port St Lucie State: FL
Zip Code: 34952 Fax:
Phone No. (772) 678-8219
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: jthieryikb@gmail.com
State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name: Sure Tec Insurance Company
_Not Applicable
Address:
Address: 1330 Post Oak Blvd
City:
City: Houston ,
Zip: Phone:
Zip: nose Phone:
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
of Owner/
of
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 • - , Lt>ci a COUNTY OF cja • LLJ1Cl 2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 26 day of 20 14 by this ,!Zday ofCX-reMADe /" , 20 14 by
ILJYN ! h l P✓1j=
(Name of person acknowledging ) (Name of person acknowledgin )
2i:n' ��
(Signaturd of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced Oil[ 1 �RE618
yCOMMISSION ii FF 1094E
Commission No.�fOgy�* aiEXPIRES:Apd12,2016
°4gcrn r 6ondNTBa9udpNdery$etvic
Revised 07/15/2014
(Signature cyNotary Pub ic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission
(Sea0AYNAJ REeIS
* MY COMMISSION A FF 109457
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