HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAlllli< IV ) k 11-7, - VA n /-). ..
ALL APPLICABLE INFO MUST r _J
BE �_PLETED FOR APPLICATION TO BE ACCEPTED
Date: 3__ 0 SCANNED Permit Number: ]M-6D-'3%
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WRIN — -1 1111 RIP BY
Ls�au ST LUCIE COUNTY
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Building Permit Application
Planning and Development Services 8107, 9
Building and Code Regulation Division clilm
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commerciale Residential X
PERMIT APPLICATION FOR: Renovation
Address.
Legal Description
Property Tax IDO-Ae�';) \ 6
-�p Lot No.
Site Plan Name: Fok_4� Block No.
Project Name: n-_e%�
Setbacks Front Back: _ Right Side: Left Side:
M-9, MA , " M1,
Condo
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Adclitional worK TO up np rtormea unclerthis permit- checic all a p p Fy-.*
[1HVAC Gas Tank E]Gas Piping Mlhllttprs [] Windows/Doors
9'Electric 20plumbing OSprinklers
Generator Roof Roof pitch
Total Sq. Ft of Construction: S f First Floor:
Cost of Construction:$ (as ,oc)o Utilities:-Sewer—E]Septic Building Height:
wt,
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NamefMtAf1_nV,,0
Name: Justin Thiery
Addr ssAcll
Company: Island Kitchen and Bath
Stat
i l!p
Address: T11875-9-0—cean- rive
City: Jensen Beach State: FL
Z Code: Fax:
-Phone Noo'�L1C1=
34957 Zip Code: Fax:
E-Mail: C�
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simpla Title Holder an next page (if different
E-Mail: ithieryikb@gmail.com; nblaszkaikb@gmaii.com
State or County License: CBC1 259508
from the Owner listed above)
If value of `construction Is $200 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name: ivanThiery
Address:
Address:
City: State:
Zip: Phone
City: Jensen Beach State:
ZIP: — Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address: 10875 S. omin Dive
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 Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conlct ict with any applicable Home Owners Association
bylaws
rules, 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
ornmencing work or recording your Notice of Commencement.
Signature of 06 ner/ Lessee/Contractor ao-Agent for Owner
Si—anat e of�tlottraor/License Holder
I
STATE OF FLORIDA
COUNTY OFstLwe
Z
=ATE OF FLORIDA
COUNTY OF st was
The forgoing mstrgrnent was acknowledged before me
this, �t4niay of 20-\B by
The forgoing instryment was acknowledged before me
thiclay of ��Q-k4. 20A_b by
"WNAVQ�e Nzy-:\"
Justin Thlery
Name of person making statement
Personally Known _ OR Produced Identification X
Type of Identification
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced Odwis Limns
Produced
(Signature of Nota c- Sta of Florida)
(Signature of Public- St of Florida )
Comm* ' n No. OH9LRAAZ
4qEAISSION#FF904140
EXPIRES: JUIY 28,2019
. :6�.
Co fissionNa. K ICHAEL RAAZ
Co
'JW MISSION# FF904140
PIRES:JUty.28,2019--
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
RE JEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17