HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED Permit Number: lei U `"1 - 6C�>/105
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 Commercial Residential X
PERMIT APPLICATION FOR: Renovation
Address:
Legal
RECEIVED
APR l 0.7019
Permitting Department
Sk Lucie County
N
Property Tax ID #: 4a)Z - U - cY 4a -CDOU _a Lot No.
Site Plan Name: 1 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
11 AC Ga ank Gas Piping
Electric L=1 Plumbing Sprinklers
Shutters Windows/Doors
Generator Roof = Roof pitch
Total Sq. Ft of Construction: Sc�Ft.I of First Floor:
Cost of Construction: $ c7c�, OiSb Utilities: —Sewer Septic Building Height:
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2k0N� Z vi,
IC-0 .a `..._..Y
Name
Name: Justin Thiery
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Addres1sGgc)y S am DTil�
A 3
Company: Island Kitchen and Bath
City:' Ip SD.v� QO t , State
Zip Code:Fax:
Phone No._':)�- Z251- 2"-)43
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: y,ta Dll�c .'r e _ CGrn
Fill in fee simple Title Holder on next page (if different
I from the Owner listed above)
E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
State or County License: CBC1259508
It value of construction is 5Z508 or more, a RECORDED Notice of Commencement is required.
SI�RPEMi NTA�OiVSTRU@i10fU LAN IA1N=�N00NIA710Is "
ry
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Address:
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
commencing work or recording our Notice of Commencement.
.Sign ure of Owner/ Lessee Contractor as Agent for Owner
5' Holder
na r ntractor/License
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St L°de
COUNTY OF sc L°ae
The forgoing ins ment w acknowledged before me
The forgoing ins�ment was acknowledge efore me
this l day of 20 � by
�T�
this _A_ day of ���n , , 20 by
JustinThiery .
Name of person malting 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 Dri�ersUmsee
Produced
(Signature of No Publi - to of Florida I -
(Signature a blic- State of Florida j
,�pF VUH(� ICHAELRAAZ
a° '• ° OSSIONtFFB04t�
MICHlif AELRAAZCommissio
Commission No. ff,,EXPIRES:
�Yi:Oh101H 1N✓<FF9041019EXPIRES:
July2S,2041
W�ie
July28,201xr
°e
�.dxBondedTnrvBudget Nbry Seni
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17