HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONT l
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '7 .y
Date: /• 16 - %Cf SCANNED Permit Number: /�� ('
St. Lu e County RECEIVED
Building Permit Application I JUL 16 2019
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
Permitting Department
R County, FL
PERMIT APPLICATION FOR: Renovation III
Legal Description: 151
Property Tax ID#:LimD2 — 6 G 1 —01ca:::!_ - �' Lot No. _
Site Plan Name: lq l of Block No. `
Project Name: k -
Setbacks Front ck: Right Side: Left Side:
c\ecarc:c�A19L" C'Ae\i
Tank UGas Piping LJ Shutters
Electric LJ Plumbing
Total Sq. Ft of Construction: Q
Cost of Construction: $ )CI=
ors L_J Generator
S Ft. of First Floor: _
UtilitiesIn Sewer [ISeptic
11 Windows Doors
ORoof = Roof pitch
Building Height:
K •}rY l.r\jpLl i,i � t SR � Mn}nt
.r#� �n
Nam C i7a/a-(.r\
Warne Justin Thiery
� S C�(` Oo Lam—ZUO$
AddreS\mf&jo
Company: Island Kitchen and Bath
City.3 (j4� State
Zip Code: ,2/ Fax:
Phone No.W✓W_�A \.4;p0 e Co\ . c-GYri
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
i Zip Code: 34917 Fax:
Phone No. 772-678-8219 - 77?_-237-7348
E-Mail: 45o O e co I • C C71^
_ _
Fill in f slrrh4 Title Holder on next page (if different..
from the Owner listed above)
E-Mail: jjhieryikb@gmail.com; nblaszkaikb@gmail.com
_
State or County License: CBC1269508
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
rSUPF'LEMEIV}TAL 'tt GONS,N LIEN SAW tNFQRMAT101 i z �¢
�b RUGTtQ
DESIGNER/ENGINEER:
Name:
— Not Applicabl'e''
'M69TGAGE COMPANY: _
Name: Justin Thiery
Not 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: 10875 S. Oman Olive
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
commencing work or recordinta-veur Notice of Commencement.
Signatu of Ow, r Lessee/Contra as Agent for Owner
Signatu a of C r r tense Holder
STATE OF FLORIDA
STA OF FLORIDA
C UNTY OF Se Lude
COUNTY OF se wde
The forgoing instr ment was acknowledged before me
The forgoing inst ument was acknowledged before me
this day of, 20� by
this Z- day ofo�„o, 20_n by
VJustin
Thiery
NarAe of person making statb4phent
Name of person making statement
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Ddvem license
Produced
(Signature of No is -State of Florida)
(Signature of No=PeFlorida2sxv
Pcqq��ICHAEL RAAZ
Comni o.HAELRAA
0,!jMIS510N�FF904140
etAFY Pp,
Commiss' No.*� `� *)
* *
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MYCAh1h95 ONtFF
grPcsnx� Ben.¢dThm Oed;¢lNofcry Services
EXPIRES: July28,
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Rev.8/2/17