HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLf INFO MUST BE COMPLETED FDAPP�ETION TO BE ACCEPTED
/%% % CAD
Date: l%% D-
BY Permit Number:
la MR w t St. Lucie County RECEIVED
Building Permit Application JUL 17 2U19
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R si&�t6y§�ie County, FL
PERMIT APPLICATION FOR: Renovation I
Legal Description:
Property Tax ID #:2 -'a GZ- OG4 I . (GCS 6 - Lot No.
Site Plan Name: L LA'Q Block No.
Project Name: 1q 0 PjCl - LAA. Q i✓lf-V
Setbacks Front Back: Right Side: Left Side:
e,�c 'M�Etia -
k7enb ce:,V A,(,'Qepk.a r1 uttl, G/Grin l,P/wwb`ny, �l,lu�er� �i�lJ
WAC LJ as Tank UGas Pipind,. L-_ Shutters
Electric LJ Plumbing Sprinklers E] Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ - Dya, ooc� Utilities: _Sewer Septic
Windows/Doors
11 Roof = Roof pitch
Building Height:
JG50111%C(OR
*t�
1 �_t LPx3r �
Name
Name: Justin Thiery
Add r ss120ion S DiNO n jlr -V 10nt
Company: Island Kitchen and Bath
City n ,ztoz" State: -E,-
Zip Code:(�C'"a— Fax:
Phone No.,.'-(1I ��- "}25- (ess?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:�r.�
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
n vaiue or construction is ;.z3uu or more, a newnutu ivotite or Commencement is required.
aSUPPL M> AFL~CONSTRU,GTIQN
L F I [X 0-MRN#ATIOW
k
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name: Justin Thery
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City: Jensen Beach
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address: 10875 S. 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
commencing work or recording vour Notice of CommencpmPnt_
PSOatu*reoft�/
ssee/Contractor as Agent for Owner
Sig tur of n actor/License Holder
STATE OF FLORIDA
S TE OF FLORIDA
COUNTY OF sr. Lucie
COUNTY OF s«°a°
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
IVCtday
this ay of 20� by
this of 20j by
/ L—e k
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
(Signature of No tale of Flor�b),FLRAAZ
(Signs- a of Notary Publis�tL�r�f Florida )
` MY co MISSION C FF 904140
Commission No. * co
pea`
Commission No. : •"•. MIC
__
YCOMMIS i 904140
P Bonded;NBud:OINOCtyBeni:es
�'Eocri°
* *
EXPIRry lNa4ry 28,
,r„'lepng &� Bonded Budget 5emce5
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17