HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED PermitNumber: M�__OQG
BY
St. Lucie County
Building Permit Application
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
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00
Residential X
I PERMIT APPLICATION FOR: Window/door I
Legal Description—Y"e _(V \C)O(
Property Tax ID #:4,50-z-ac-a--c�4i -c�)c�oz--:i- Lot No.
Site Plan Name: W -�8- � A -eL Block No.
Project Name:WAA-
Setbacks Front Back: _ Right Side: Left Side:
<:AC�CY_5
(!�k0tSS <fk004r_S Cl'�>/ 1Y_r_'9CL C::�_r
Windows/Doors
Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: olF�Lo Utilities: 0 Sewer [leptic Building Height:
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Name Ap
Name: Justin Thiery
Acldr�sss�:9`kk 90 'S_ C*_Q_QSr7NL Z)� 4-100(
Company: Island Kitchen and Bath
City v ?�e J:AA�A State:
Zip Cocle�7--+�- Fax:
Phone No. 416
Address: 10875 S. Ocean Drive
City: Jensen Beach — State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: nla-
Fill in fee sii�nlple Title Holder on next page (if different
from the Owner listed above)
E-Mail: ithieryikb@gmaii.com; nblaszkaikb@gmail.com
State or County License: CBC1 259508
If value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name: JusfinThiery
Address:
Address:
City:
State:
City: Jensen Beach
Zip: Phone
Zip: — Phone:
—State:
FEE SIMPLE TITLEHOLDER:
—NotApplicable
BONDING COMPANY:
Applicable
Name:
Name:
—Not
Address: 10875 S. Oman Orwe
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 mayhriestrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions w ch 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 properLy. 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 your Notice of Commencement.
�1, �nre�of �OwnW' aess:pr'6�/Contractor
as Agent for Owner
Signa ontf4ct
tD��" rXcense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOFstwd-
COUNTY OF at —
The for cing mst�umqnt as acknowledged before me
The forgoing instkument was acknowledged before me
this _9 day o' 3 A A� 4 , 20�n by
this 112) day of�_u ,-k i6 20ft by
'J I I A jo % neJC
Jushn Thiery
Name of person making st'atement
Name of person making statement
Personally Known _ OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Dnvers License
Produced
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(Signature of Nota ecfFI r1w,
(Signature a Public- a,
ar'
(S�ignatue ary Public- ate of Florida
28.2023
Com rm. 0.
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tw"safts
mission # Go 31
Exores.lul�28.20
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17