HomeMy WebLinkAboutBUILDING PERMIIT APPLICATIONALL APPLICABLE
�INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: �— f SCANNED Permit Number: -1
BY
RECEIVED
1201011 saw St. Lucie County
MAR 0 7 1018
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 Commercial
Permitting Department
St. Lucie County
Residential X
PERMIT APPLICATION FOR: Renovation III
Legal Description:
Property Tax ID#: UZ--�{� - U 1- OOG-�-
Site Plan Name: {
Project Name: I�'1UZ`�— C1✓ l�_�
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
Muamonai worKio De errurmeu
❑HVAC Gas Tank
unuer ims
perms —cnecK all
Gas Piping
apply:
❑ Windows/Doors
Electric
LJ
Plumbing
[]Sprinklers
_Shutters
Generator
0 Roof
=
Roof pitch
Total Sq. Ft of Construction:
��jj
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer E]Septic
Building Height:
Kati
Name C /12S i�C.�
Gi P
Name: Justin Thiery
/V-)0_
Address: — �C)LsJ C S. DC,eGr�
Dy— _-US
Company: Island Kitchen and Bath
City:, � 0 Q A State: ff—
Zip Code: 34gf5 1- Fax:
Phone
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: Q Y c 1 Ch id.. net
Fill in fee simple TidJ 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.
9UPPLEMEA VOODOO* _NSTRU-� 1 OWN tIENIAVU 1
DESIGNER/ENGINEER: _ Not Applicable
Name:
Ong
MORTGAGE COMPANY:
Name: Jusun Thiery
_ 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: 10e75S.Oman Ddve
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. "ou intend to obtain financing, consult with lender or an attorney before
commencine work or recoYdiniz vour Notice of Commencement.
J
ignature of Owner/ 'e ee/Contractor as Agent for Owner
Sign ur lf ntr for/License Holder
STATE OF FLORIDA
ST TE OF FLORIDA
COUNTY OF St Lude
COUNTY OF st wde
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IZ day of �-e_ _lo
_, 206 by
this 1_ day of ¢ 20_ � by
/
e'y\c.
C1
. S l
—� P.
1 Y-T- r\ OLI
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
Produced
( ignature of ry Pub'
Late of Florida)
(Signature of No lic- a of Fl�orµld�a
�,
c"0 post, MICHAEL RAAZ
...,
o� ; .. FAICHAEL HAAZ
Com ' sion
: ;
(Sey1jCOMMISSIONPFF9041
Co fission AIM""0\!'dI55r1?'tFF
EXPIRES:Juty28,2019
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17