HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr/V �17 Cvslma(1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2
Date: Permit Number: !� (,-o's o
Building Permit Application DEC 141010
Planning and Development Services permittln0 Qeparfinent
Building and Code Regulation Division
St. Wcle Count/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renevatm ( \.. 41 . \ / III
Legal Description -TIE \e HAkztc y, ,C, � &Lg, 4
Property Tax ID#:G15C%,Q A111 o- o\- [b- CiC)G-Lot No.
Site Plan Name:W -4A �-
Project Name:\[V 1-t -r- ( .ram,
Setbacks Front Back:
4P [cic 0 S I: I; n G lAss
HVAC L_1 Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
'Cost of Construction: $ G
Right Side:
()crorS uv,
Left Side:
I M
SCANNED
BY
Piping LJShutters
nklers 0 Generator
S Ft. of First Floor: _
Utilities:0Sewer Septic
Block No.
rS
Windows/Doors
Roof = Roof pitch
Building Height:
CINNER/IFSSEE;
GONTRAGtOR
KYw�r a �
Name...\�Pv G�PSSv-v-�rr�
Name: Justin Thiery
'1
Address�L�� S. Gf o or` DC, �r121 6
Company: Island Kitchen and Bath
City "A-% Stater
Zip Code:, _ Fax:
Phone No.;�16_,,,�- O ,�a�o
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No.772-678-8219 - 772-237-7348
E-Mail: ,ti,G
�^
in fee simple Title Holder on next page (if different
from the Owner listed above)
thie ikb mail.com; nblaszkaikb@gmail.com
E-Mail: 1 ry @9 @gmail.com
State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY:
Name: Justin Thiery
,IY.-,;,
4y"
MR
m :Id x. 4..: �z
_ Not Applicable
DESIGN
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Jensen Beach
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address: 10875 S. ocean Drive
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 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 attornev before
Ommen Cing worK or recoraing your Notice ar t.Ommencement.
Signature of wrier/ Lessee/ ontractor as Agent for Owner Si r of Contractor
STATE OF FLORIDA ST E OF FLORIDA
COUNTY OF Si Lad COUNTY OF Sc wde
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of GC'-rr-Ab a. - 2W'6 by this day offrtolarr 20� by
Name of person
making statement
Personally Known
OR Produced Identification x
Type of Identification
Produced License
dDDridVers
(Signatur ota
lic- State of Florida )
Co Sion No.
°t".c: P"
+ (Seal) MICHAELRAAZ
MY
* * COMMISSIONAFF90414
ERPIRES: July 28.2019
REVIEWS I FRONT ZONING
COUNTER REVIEW
ev
Justin Thiery
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced
FROSM
(Signature of �ry Pu ie�Sfate of Florida )
�� " �e� (��dELRAAZ
Co ion No. e° -
* MYCOMMISSIONtFF904140
SUPERVISREVIEWOR I REVIEW PLANS I VEGETATIEVIEWON I SEA REVIEW TURTLE
VEWLE M EVIEWVE
Q