HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL-AICABLE INFO MUST 13E COMPIJETL�i.��JR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie Countv CEVED
Building Permit Application
Planning and DevelopmentServices G 24
Building and Code Regulation Division 2 county, Permitung
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax*.(7F72)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: P
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: —Ttsc�,
Setbacks Front
11HVAC U Gas
RE'lectric 2511'ur
Total Sq. Ft of Construction:
Cost of Construction: $ t �
City: �3CA�Se-ln t5f-0-C
Zip Code: 3'kck5--)
Phone No.
Right Side:
Left Side:
Piping L-.j Shutters
nklers Fl Generator
Sq. Ft. of First Floor:
Utilities: 11 SewerEl
Septic
State: _a,
Fill in fee simple Title Holder n next page (if different
from the D
Name: Justin ThIery
SIM(o - I
Lot No.
Block No.
[]Windows/Doors
11 Roof = Roof pitch
Building Height:
Company: Island Kitchen and Bath
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: ithieryikb@gmail.com; nblaszkaikb@gmall.com
State orCounty License: CBC1259508
if value of construction is $2500 dr more, a RECORDED Notice of Commencement is required.
DESIGNER/lENUINEEK:
Not Applicatile MORTGAGE COMPANY: Not Applicable
Name:
Name: &-fin-mery
Address:
Address:
City:
State:
City: Jenwn B�ch State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: —Not Applicable
Name:
Name:
Address: 10875$- 0— D&*
Address:
City:
City:
ZIP: Phone: I
I I
Zip: _ Phone:
OWNER/ CONTRACTOR AFFI
I
I IT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installatio
has commenced prior to the issuance of a permit.
St. Lucie County makes no represe
tation that is granting a permit will authorize the permit holder to build the subject structure
ble
which is in conflict with any applic.
structure. Please consult with you rilHome
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
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 pi ans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit appli�cations are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming p*1s, 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 prope O�A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If intend to obtain financing, consult with lender or an attorney before
commencing work or recordir(R)Ivour Notice of Commencement.
X
-signitu're of Oikner/ I -fAee/Coni
ractor as Agent for Owner
ignat on ctor/License Holder
STATE OF FLORIDA
=TATE RIDA
COUNTYOFst�
COUNTY OF st u�
The forgoing instrument was ack
iowledged before me
The forgoing instrument was acknowledged before me
this k day of AaxcLLSA
20_a by
this _ day of . 20_ by
Justin 11�ery
Name of person making
statement
Name of person making statement
Personally Known OR P'oduced
Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Kim— U--
Produced
(Signature of Nota State
of Florida
(Signature of N da)
Commissig 'W
'y Po, S HAEL RAAZ
Commission N
WCOU�VlfesloN# F9D4140
140
E,XPTES: July 28,2019
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Rev. 8/2/17