HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONU
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \\ '1� \'n SCANNED Permit Number:
- BY
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St. Lucie County
Building Permit Application NOV 2 1 2017
Planning and Development Services PEWAITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renovation
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Property Tax ID #: �Ss ,s' (Db) - a-R-• (�i 1J� - �i Lot No.
Site Plan Name:�,% — K Ack4n Block No.
Project Name: W. -L[` er, Qeeyr zlel
Setbacks Front Back: Right Side: Left Side:
LA
GGasTank ❑Gas Piping _Shutters Windows/Doors
E2Plumbing ❑Sprinklers Generator DRoof Roof pitch
Total Sq. Ft of Construction: SFt of First Floor:
Cost of Construction: $ ;i51 ck60 Utilities: Sewer Eleptic Building Height:
Address: $7,% b !:� nCe-P*z- :0r
City: 6e4x.A^ State: fL4
Zip Code: 3 Lk Fax:
Phone No.
Name: Justin C. Thiery
Company: island Kitchen and Bath of the Treasure Coast
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-237-7348
Fill in fee simple Title Holder on next page (if different E-Mail: lthieryikb@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.
"DESIGNER ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name' Name:
Address: Address:
City: City:
Zip: Phone: Zip: 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,
accessary 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 recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Si a ur f traMo/LlcenseHolder
STATE OF FLORIDA E OF DA
S COUNTYOF Ae- ustsCOUNTYOFnwde
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2 day of ML-& Hr�rI . 20 aby this _ day of 20 _ by
Justin C. Thiery
(Name of person acknowled I ockxfe— I (Name of person acknowledging)
(Signature of Notary Public- State'of Florida) (Signature of rnx
Pu i - State of Florida )
Personally Known OR Produced Identification �_ Per all OR Produced Identification
Type of Identification Produced n L.T dentiProduced
o1Pus� MICH91. x°;•••;Vo MICHAELRAAZ
Commission No. * * jy"gM15SIo%#FF994140 Commission No. * MY00MMISS10N#FF
* EXPIRES: July28,2019 or EXPIRES: July 28,20,
m ThrvBud9etNolary Senxes 9jrr..,oa Bonded Thm BudpiNotrySe F.
EpFF
Revised 07/15/2014
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