HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:rd.a1�� Permit Number:
SCANNED
IP w; ` ' i �.,�..�: -" By RECEIVED
St. Lucie County
Building Permit Application MAY 2 3 Z019
Planning and Development Services
Building and Code Regulation Division ST. Lucie 6aumyi Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 6
PERMIT APPLICATION FOR: Renovation- c d V` Am III
PROPOSED IMPROVEMENT LOCATt0N "1#
Property Tax ID #: �36 - woz Lot No.
Site Plan Name: - Block No.
Project Name: 3-
Setbacks Front Back: Righ 5' e: Left Side:
Masj, OAcQ C t~'Ra,,v>,��o.. Demo oos-Nng ba+hrpoms, I1`15t4ll shb!W Valens.
iris+qll sgpllo and drnlfu h V-allitles , In5+gll nrW v3chlutef., shavW sys-teens rh
snDav Dvteas. tns-rntl 17ew -rite I cabunct-s mn( tops . 12o�gh m ana Instqu rulo IPds
1V\+C ,l'1NV1Qr nreA. 12MU, eV.hUlAW Lr h 12P,D10ro_ dtUWrlll O.t hire n,f , II1WnIl MAI
❑HVAC u Gas Tank ❑Gas Piping
_Electric I —Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ c31,00
Shutters Windows/Doors
Generator E]Roof = Roof pitch
Sai —F—t.� of First Floor: _
Utilities:Sewer Septic
Building Height:
11
01/VNER(LE5S�E1,x�
.
.
GQNTRACTOR M n,
_k.
Nam '
Name: Justin Thiery
Addr ss: �4
Company: Island Kitchen and Bath
Citvt���/i-PM State: 1131
Zip Code: 34C6-1- Fax:
Phone No. -)-I 1--aiS -1 - --):34 F
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: al A
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.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Add ress: 10875 S. Ocean @'rve
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
N a m e• 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
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as IMfor Owner
Si a e ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF at waa
COUNTY OF st. Luua
The orgoing instrument was acknowledge before me
i
The forgoing msjjr�_ument was acknowledged before me
JC1
this ay of 20 by
this —VO)tlay of jam, 20by
y
\ Q
Justin Thiery
Name of person making statement
Name of person making statement
Personally Known OR Produce ntification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Driers License
Produced
('nature of Notary Public- S of - orida)
(Signature of Notary Public- State of Flori
Commission No x°�a.T•e. o N(Sd&f?tl
O1Y eBC
Commission No. ? o CHAEL
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SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17