HomeMy WebLinkAboutBUILDING PERMIT APPLICATION\9.f1t\ e_
ALL APPLICABLE INF�O7 MUST BE COMPI',,. , °D FOR APPLICATION TO BE ACCEPTED
Date: I3 x Permit Number: O
SCANNED
BY
• St. Lucie County
]CEIVED
LAPRCI
Building Permit ApplicationPlanning
and Development Services
Building and Code Regulation Division ting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Renovation
Legal Description: �� �, `C T C,Y-� D�•r-��r1�� \ ,l �r\.�-i- �% � �J
Property Tax ID #: W Lot No.
1-��p
Site Plan Name:c�I�-RQt 1 CiQ�CI ✓� Block No.
Project Name: 1 t um- 1-C��Y1L� pXsC./ 1
Setbacks Front Back: Right Side: Left Side:
Addfflopal wor to e e orme under iIspermit-checka apply:
C M GG s Tank ❑Gas Piping Shutters Q Windows/Doors
_
Electric L_I Plumbing OSprinklers ElGenerator EIRoof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Cam r 80� Utilities: Sewer Septic Building Height:
��77 ��
Named1�1C>2 � i&Y1E fa I�
Name: Justin Thiery
Addre\\s__s�� D(P_0r-\ jay *
Company: Island Kitchen and Bath
-L-2�Dao
City&]tJ, SDy-) Stater
Address: 10875 S. Ocean Drive
_
Zip Code'&IPL9J� Fax:
City: Jensen Beach State: FL
Phone No.7I1 CD - uGiLl - I �LC:>I.a
Zip Code: 34957 Fax:
E-Mail:1� YAPS\ �(` rC' YY?i SVYI . 17-11flk
Phone No. 772-678-8219 - 772-237-7348
Fill in fee simple Title Holder on next page (if different
E-Mail: jthieryikb@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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAM: COMPANY: Not Applicable
Name:
_
Name:
Address:
Address-
City: State:
City: - -- State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Ad d ress: 10875 S. Owen Dnve 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 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 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
cornmemcing work or recording our Notice of Commencement.
Sign ture of Owner/ Lessee/Contractor as Agent for Owner
natu oVonra r/License Holder
STATE OF FLORIDA
ZATE OF
COUNTY OFSr was
COUNTY OF Si u,oe
Theforgoingins ment w as acknowledged before me
thisday C?✓ \ 20Uby
The forgoing inst ment was acknowledged before me
this day of �Jvi \ 20_e by
/o�fl�l
��
Justin 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 Driver; Uwnw
Produced
(Signature of Notary b tote of Florida)
MICWEL�Commissi
(Signature iNaC ublic- S of Florida )
��JYCOMNtFF9041
S:JBIy28,2019
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mmission#* MYCO1
BcnCedit,NB'>d9NNotar/Sank
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510NJFF964140
EXPIRES:July28,2019
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Rev.8/2/17