HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: H b _ 001 SCANNED Permit Number: I '1� `� 0362
On BY RECEIVED
` � �t. Lucie County
JAN 181019
Building Permit Application Per
Planning and Development Services St. Liu®aVNment
9
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578. Commercial �_ Residential X
PERMIT APPLICATION FOR: Window/door
Address:'E:A50C�' S- C)CQ� L A��
Legal Description:
PropertyTax ID #: �-tSO2 - LCCSZ _ 01 CA2 1 - OOO -�-
Lot No.
'`��OX��
Site Plan Name: W-�4�0"
1t°�1 Block No.
1nL
Project Name: \fl-40t - :)o = -�Jff�
Setbacks Front Back: Right Side: Left Side:
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C. Ru aNl�ruF�oRn aTioN e 5k s
iLona wor to e e orme un er t is permit- c ec a- app y.
❑_ HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator g Roof Roof pitch
Total Sq. Ft of Construction: S Ft, of First Floor:
Cost of Construction: $ pZI �O & Utilities:11Sewer Septic
t Building Height:
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pow /E="k�12o�1TrroR� `r t N'.
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Nam Name: Justin Thiery
Addressg50b S. CDc=v , -D" cry Company: Island Kitchen and Bath
City�IQ y-,sQm--% State: FL Address: 10875 S. Ocean Drive
Zip Code: 34C6j } Fax: City: Jensen Beach State: FL
Phone No.`61i- Zip Code: 34957 Fax:
E-Mail: — 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@gmaii.com
from the Owner listed above) State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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�PPLE�EI�MA�4L CONST�UCTiO N LAW 11UFOR"IVIp�"TC�IU:
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY:
Name: Justin mien
_Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: Jensen Beam
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address: � os�s S. ocean Dave
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 attorney before
commencingwork or recordingour Notice of Commencemen &4t�� �]�
Rev.8/2/17
4 Signature of Owner/ Lessee/ ontractor as Agent for Owner Si r of Contractor/License Holder
STATE OF FLORIDA ST ZVY
OF FLORIDA
COUNTY OFstwde CO OFstwae
The forgoing instrument was acknowledged before me The for Ding instrument was acknowledged before me
t1/h�is`�—Ld�a�y of�,�1 ��']a:>�• 20�by this day of 20�by
�/W �./t�., 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 oAvers License Produced -
{Signature of Notary Public -Stat Igpd6v�, MI orida
+°: •• ` yyCAMMI5SI0N9FF o'�nature of Notary Public -
Commission N EXPIRES:Juty28, i°"F::°�c� (Sea ICHAELRAA2
9u69V1Not >�PS�f4lmission !�1
sr yF°� 9Mdo6mfl * * MY CO MISSION S FF 904140
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� EXPIRES:Juty29,2019
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