HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED Permit Number:
BY
St. Lucie County p .4o.
0W I
Building Permit Application S<"9
Planning
Building and Code Regulation Div s on `CJPCa��ry�Pop
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
Adclress:C71'55C) S.
Property Tax ID#: '�A5b2-tDC>I -OC 7:(C> -yU0 - zs Lot No.
Site Plan Name: Block No.
Project Name: - 2�yiC'rr
Setbacks Front Back: Right Side: Left Side:
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MUUMUud i wuirt w uc ei IUi Ircu wiuei uiu Peinu L—uiecrcdu apply:
11HVAC _Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric OPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ %i�r CX> 0 Utilities. 0Septic Building Height:
r > �, :: r�'*1 i 3 a r y a ,, t x.z
:OINiVEFi%LESSE�'3s� *(( r„ rail
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a r
CONTRACTOR ,
Named O
Name: Justin Thiery
Aciclress:c1 S. r. loy- CX)lo
Company: Island Kitchen and Bath
City:, kn<;'-P,f1 13�GC� State:�z_
Zip Code:3 G _- - 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:
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.
SUPPL'EMEfUTALCONSTUCTION LIEN LAW#IIVFaRMATIQRI
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
N a me: Jusbri Thlery
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City: Jensen Beach
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: 10875 S.Oman Drive
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 finaricing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
0 29665��
, '��n
ature of Owner Lessee/C tractor as Agent for Owner
Sign ure of Contractor License Hold r
STATE OF FLORIDA
ST E OF FLORIDA
COUNTY OF SLLutle
COUNTY OF sL Lwa
The for oing inst ment was acknowledged before me
F
The for oing ins ument+.v s acknowledged before me
this day of 2041 by
this day 2019 by
U Z � i.1Q.��U (' ✓�
Justin Thiery
Name of person making &ement
Name of person making statement
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Driven, License
Produced
(Signature of Notary P 1i�S�e of Florida)
(Signature otary P State of Florida )
Commis' No. o��c.�c.°fig (Sea NICHAELRAAZ
CommissionissionN�MICHA(OfflAIZ
* MY COMMISSION t FF 904140
Jul 28.2019
, t y COMMISSION o FF 904140
EXPIRES:
� g EXPIRES:J028,2019
h servkes
�p
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17