HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED � Permit Number: �Ip " C)p
BY RECEIVED
St. Lucie County,
Building Permit Application JUN 12 2419
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
Permitting Department
St. Lucie County
PERMIT APPLICATION FOR: Renovation III
Legal
e
Property Tax ID #: GOU— 4J Lot No.
Site Plan Name:
Project Name: ►"1 V L D- c7Vl
Setbacks Front Back:
Right Side: Left Side:
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LIHVAC LJ Gas Tank UGas Piping
Electric E Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ M' ioo
Shutters [] Windows/Doors
Generator LJ Roof = Roof pitch
S Ft. of First Floor:
utilities:SewerE]Septic Building Height:
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;CIWNER1LE5 E s ��r„ a4`.
CONTRA4OR
Name e-d
Name: Justin Thiery
Address ( \o-
Company: Island Kitchen and Bath
City: Qt ov- State:
Zip Code,340k4_1 Fax:
Phone NoA9D2 -a.Oln -
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@gmaii.com; nblaszkaikb@gmail.com
State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM tx CONSTRUCTIONLiENLAWgINFORMAT(QN
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name: Jusfin 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: 10875 B. ocean 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
commentinzwork or recordine vour Notice of Commencement.
(gnat
ignature of 0 er/ Lessee on ctor as gent for Owner
ontra or/License Holder
STATE OF FLORIDA
ATE O RIDA
COUNTY OF St. w=ie
COUNTY OF St Lade
The forgoing instrument was acknowledged before me
4 VN
The fc going instrument was acknowledged before me
this day of )Cy-GU-� 201q by
thisday of . 2oAaby
EAWL—'6 &ro' �p
Justin Thiery
Name of person makidi 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
of ary Public..Sgt4Rf Florio � EL
(Sign RW
(Signatur Notary Public- �gfklgerida )
. * My�6 SI0Y#FF904140
mmission No. - E 428,2019
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Bwdk Thru Bud^e1Nofa ServicestF
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�'�osaoa`O� EXPIRES.41g0
8Md,dTANau Jul"'T. 2019
rv�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17