HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number: ict
SCANNED
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL.34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Window/door
Address:
Legal Description:
S.
Commercial
Residential X
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Property Tax ID#: g15U2Z-i,DC>2-- 0\C-Lk C>UG Lot No.
Site Plan Name: [LA-Y—iV--(�_-ke i Block No.
Project Name: W- 61- l
Setbacks Front Back: Right Side: Left Side:
1Le�p� e e 5U- 6zn 91r,Ss dcUr5 � -\ tA-e vy-)GSto- b-0 ar-0 cxri "'
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Str �t�cN W `�1tJ� ��hc S
°IILTIONINOyRMMIA*TF)N '9 n ...d .
Additional wor to e e orme under tis permit - cneCK all n apply:
0HW Gas Tank Gas Piping Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2b, 000
S Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
xOWl 11K,. '
* ��y m $�
GO�NTR'ACTO - },'" a
Name'F t )L PIC
zc"%- c
Name: Justin Thiery
Addre\ss:'`J� S: C>[fr r�
�r pl t'� -
Company: Island Kitchen and Bath
City: �e_nse n State: FT,
Zip Code: Fax:
Phone No. WS - c'1Ct2- 1P?_09
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: Kzarr+erFcld• i1 ct tcac, cw
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
City:
Zip:,
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 10875 S. Ocean Drive
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: Justin Thiery
Address:
City: Jensen Beach State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
commencin vo c or recording vour Notice of Commencement. n
nature wi. r/ Lessee/Contractor as Ag for O er
Sig Contractor/License older
OT"ATE OF FLORIDA
S A OF FLORIDA
COUNTY OF SCLeHe
COUNTY OF st wce
The for Ding instrument was acknowledged before me
The forgoing instrument was acknowledged before me
trhis�dayof �Pllln�r r.n 20 by
this �day of20L by
Crfi,n� L ��yyl`2yG�7� Pw'--`—Tit Gl
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 Dnvers License
Produced
(Signature of of Florida)
(Signature of No ublic- S e of FloridaCommiss'
�Notautate
N,°�''F: "ue�H (Seal)MICHAELRAA2
Commiss' n N :�Y'(�I) MICHAELFIAAZ
_ _.; _ MY CONIh11SSI0N 6 FF 904140
July 28, 20190
_ _ _ * �. MY COMMISSION 8 FF f
EXPIRES:
EXPIRES: July 28, 2
°, Rudd Thm RudnetNotary Servkm
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Rev. 8/2/17