HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 111 a 1 SCANNED Permit Number:
BY RECEIVED
St. Lucie Countv
MAY 2 3 2019
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Renovation—Cpr\An
Address: 4-11\OU nl1�,,L�� VA-,.
Legal Description:C DQQD<--Ii
Property Tax ID If:
Lot No.
Site Plan Name: JC5)C SC*n Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
il.fda+e all electriCd
ow as, $ lI htlnq , ltty\L)& eY1541nq UI Irl6tS In VI{TI= 4 VI lacL wlnew. Wtv (ddntEi il))
li11= Wq TaLA11. Convert- BnrOp tO C0UnL7trtD17.
CONSTRU SON=INFflRIV� T(ON f,
a N_ .�a�._�,... ,.,,ra. �. .`� {M, �.5 *.. !r wf_b�� 3 a+X.• 2t l..er #�`"' : ri a > of a d t'2'•^ >.A� S
t7idd` ional work to e e orme under this permit— check all tnat apply: z, .,f•'. , . M _.,
VAC s Tank []GasPiping Shutters ❑ Windows/Doors
_ Electric L"J Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ cS;oo OUtilities:Sewer Septic Building Height:
OWNER .�:tiG7NTEACTOR�
Name
Name: Justin Thiery
Add��r��e�ss��A"�lWO N4 1-%..5y N l W 1C�c� A-
Company: Island Kitchen and Bath
Cityitl,tClS DSctn lsuynd State:'
Zip Code:2 �4 R Fax:
Phone No. 0r-52--`-)1c:; —'1'L�S/LP
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-2374348
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.
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ir
S�JPPLEMEf�TAICONSTRUCIION 11EN LAW,INFORMA710iV
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name: Justin Thiery
Nat Applicable
Address:
Address:
City:
Zip: Phone
State:
City: Jensen Beach
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name'
_ Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
Address: IG875 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 financing, consult with lender or an attorney before
commencine work or recordine vour Notice of Commencement.
W r-R "t ,
,!'Signature of Owner/ Lessee/Contractor as Agent for Owner
gn re o. ontra or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St was
COUNTY OF st. wee
The forgoing instrument was acknowledged before me
The f rgoing instrument was acknowledged before me
this day of 20TNy
this�F'dayof M0!&A ,20L by
D2\�:A
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
aYy - jq'GHAgl, RAr12
PFY P e
nllruLiAELFIAIa
(Signature of Notary bl '`fFWQf ,1D115SI01VAFF904140
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(Signatureo aryPubli t fFiRddMAMSSION#FF90*0
* *
EXPIRES: July 28, 2019
EXPIRES: July 28, 2019
Commissi s>°P�T Bond[SeWlIudgetNotary Senlim
mmissio ,xfi� Ba�tleCtF.e�Q�t Notary Banker
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17