HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICARLF INFn MLIAT RF CnMPLETED FOR APPLICATION TO BE CEPTED
Date:
or, Permit Number: 11 la,- 0311
BY
St. Lucie County
Building Permit Application REcEIVED
Planning and Development Services
Building and Code Regulation Division DEC 14- 1010
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Reside!nt1A'eX0"nv
I PERMIT APPLICATION FOR: Renovation I
Address:
Legal Description:
I
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PropertyTax ID #: -q 5042 - (or)j- - C)Lol -CLno- 7 Lot No.
Site Plan Name: 'F�A)g-fr- Block No.
ProjectName: 02�2.5i- 56AJOeg-
Setbacks Front Back: _ Right Side: Left Side:
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Gas Tan
UI]Utr 11115
E]Gas
PtUrT111 - LneLK dil
Pi.
dpPly:
Shutters
Windows/Doors
i0e
F811plumbing
OSprinklers
-
ct ric
Generator
Roof
Total Sq. Ft of Construction: SC Ft of First Floor:
Cost of Construction:$ AMD Utilities: n Sewer 0 Septic Building Height:
Roof pitch
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Name AfZn4t&L BG-ONC-11
Name: Justin Thiery
Address:35L-A) 6 - 0c.,ex412,r. '4 1707
Company: Island Kitchen and Bath
City:,I�Asedn -0&dLak_ State: FL,
ZipCode: FLjc)5'j Fax:
Phone No. 1� I q - r7 9_3 - IoL) (P 3
Address: 10875 S. Ocean Drive
City: Jensen Beach State. FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: re4-1 &I. ma v-,'e 0 VyArj 7 ny�i
,,w.
Fill in fee simple Title Holder an next page I if different
from the Owner listed above)
E-Mail: ithieryikb@gmail.com; nblaszkaikb@gmail.com
State or County License: CBC1 259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
E �1
DESIGN ER/ENG [NEER:
Name:
Not Applicable
MORTGA E COMPANY:
N a me: Jusunwery
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City: Jensen Beach
Zip: _ Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
—Not Applicable
Address: 10875 S. Oman Dfive
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 ermit holder to build the subject structure
which is in conWict with any applicable Home Owners Association rules, bylaws or an9covenants 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
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for wrier
gna Z) Cc ractor/License Holder
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STATE OF FLORIDA
FLORIDA
COUNTY OFSLLUCIO
COUNTY OF sL wd-
The forgoing instrument was acknowledged before me
g
The f r ing instrument was acknowledged before me
i L)e6gjwJ2eA, 20_1b by
thisjQ�Lclayof LLeernb6.r- 20_& by
ths7dayof
AIrh,r4e_&2,,7eit—
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 Drivers License MlcH9LRW
Produced ..sy P".
MUHAEL RAAZ
MyC0q,MlSSl0N#FF904140
I EXPIRES: JU111 28,2019
wi,044
7904140
EXPIRES: July 28,2019
IV81702P =nIRESrS.
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Nkm
(Signature of �Npu -State o orida
(Signatur otary Pub' e of Florida
Comm! (Seal)
lis
s' . _ I Z
ommis 0. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17