HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.i
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ALL APPL!Q ABLE INt F�MUST BE COMPLETED A?QLLCATION TO BE ACCEPTED Q 4 /W
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Date: \ BY Permit Number: I l O U� I
St. Lucie County
RECEIVED
Building Permit Application
Planning and Development Services AUG 0 7 2019
Building and Code Regulation Division ST, Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 g
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial O Residential X
PERMIT APPLICATION FOR: Renovation
6--�,
Address: b�(— 40clu
Legal Description:I({'
I lA YNI- t 00G
Property Tax ID #:_2z,2JF5 C3 \&q:— Sao— 3 Lot No.
Site Plan Name: RQLAiS-`s . Block No.
Project Name: I q 1 \2 -
Setbacks Front Back: Right Side: Left Side:
1142A—
rtiona work o [e e orme under this perms — check all apply:
11HVAC GasTank E]GasPiping _Shutters ❑Windows/Doors
L-JElectric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1 �a�r7 Utilities:Sewer 0Septic Building Height:
r
Name
Name: Justin Thiery
Address:SM'U S Q Q1T !�r
Company: Island Kitchen and Bath
City:,10 0 State'.
Address: 10875 S. Ocean Drive
Zip CodeL2Arfl!6-�- Fax:
City: Jensen Beach State: FL
Phone No.
Zip Code: 34957 Fax:
E-Mail: G.0 A . GGr,-,
Phone No. 772-237-7348 772-678-8219
Fill in fee simple Title Holder on next page ( if different
E-Mail: jthieryikb@gmail.com, nblaszkaikb@gmail.com
State or County License: CBC1259508
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
?H� 'R{tlY-. Y At •• • T13 ptt.Y pay"..
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DESIGNER ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Na me: Juga Teary
Address:
Address:
City: State:
City: Jensen Beach State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address: 10875s.0-mDme
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
as Agent for Owner
STATE OF FLORI
COUNTY OF '� lA t�Q
The forgDing instr ment was acknowledged before me
this ZV day of 20L by
o�C 16'34Z,124
Name of person making statement
Personally Known OR Produced Identification
Type of Identifica ion
Produced [✓
(Signature of Not ' - tate of Florida )
Commissi No.'r (iU'dl(1 1102
Commleelon#00316620
a .s ExplmJuly28,2023
REVIEWS I FRONT ONING
COUNTER I REVI W REVIEW SUPERVISOR
U7_\Iq
Rev.
Si nat q, on ctor/License Holder
STATE OF FLORI
COUNTY OF —
The forgoing instryymentwas acknowledged before me
this �A day of &20_ by
�AC�nV\ t-Cnn/�
Name of person making state t
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of ublic- a of Florida )
vrL RMZ
''H•r l
Commission No. n�!n..,,� 1A(Sea_._._._. ._
'a.202300
PLANS I VEGETATION 15LE MANGROVE
REVIEW REVIEWaF�WAiPE W