HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CON.. __TED FOR APPLICATION TO BE ACCEPTEL'
Date: 2% J b SCANNED Permit Number: � � T 0
BY
St. Lucie County RCrZft
Building Permit Application APR 272018,
Planning and Development Services Permitting
Li a Building and Code Regulation Division St. Ed@Ip gBfl�egt
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renovation
Address: l x ox(� S U O Ds e it=�C�l 'k �D�t1 1 LCL, i,l�-, 3uel �
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Legal Description: �tA l rk Cv-Psr ('Xldc n tt� i, Nv
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Property Tax ID #:\-�l i _rj 1 (0- ocr, (D- C C)o -Li Lot No.
Site Plan Name:�nA-KY_Pt)ci 1, A-e y— , Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Loc�cLo c�mo�e.,� .Demo i�acv�,� inrnbtrl.
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cic�� wa 11 ?Ile. , cpc�v� ems► cp� �-t-c.. ,
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d'artional w orK to orme un ert is permit-'c a app y:
�HVAC MGasTank Gas Piping _Shutters Windows/Doors
&Electric Rf
Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sryy of First Floor:
�Ft.
Cost of Construction: $ JJ. nod Utilities: nSewer E]Septic Building Height:
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Namex-)O ' n my o.b,s,n,�
Name: Justin Thiery
Address:iCilDSD 5 CSCz_ br gGc7
Company: Island Kitchen and Bath
_City:�102enn Stater
Address: 10875 S. Ocean Drive
Zip Code:31_ qPo _ Fax:
City: Jensen Beach State: FL
Phone No.. -)-a - 23"7•
Zip Code: 34957 Fax:
E-Mail: a
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple I 1 le H deron-next, page (if different
E-Mail: ithieryikb@gmail.com; nblaszkaikb@gmail.com
State or County License: CBC1259508
from the Owner listed above) .
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 10875 S. ocean Ddw
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
N a m e: Justin rhiery
Address:
City: Jensen Beach State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 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
commencine work or recordine vour Nntire of cnmmPnramant
x
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SignSigna uure of Owner/ Lessee/Contractor as Agent for Owner
Si a re of Contractor/License Holder
STATE OF FLORIDA
ST OF FLORIDA
COUNTY OF SL Lude
COUNTY OF sL wtie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2_lg day of T> ( 20_& by
this day of Q.0yj 1 20jQjby
Justn Thiery
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Diners License
Produced
(Signature o Public -State of Florida)
(Signatur�otary Publi - ate of Florida )Publi - ate of Florida )
Commission No. Frr (Seal)
Commission No. (Seal)
IC LRAAZ
. * MY COMMISSION 6 FF 904140
gs�`'°uev� MK:HAEL RAAZ
°• •••
EXPIRES:, bl2
* My CAMMISSION d FF 904140
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17