HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / (/�,
Date: Permit Number: l RFc�/�
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SCANNED
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OCT 0 2 2019
IL 4• St. Lucie County
-- - Permitting Department
Building Permit Application St. Lucie County
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
PERMIT APPLICATION FOR: Renovation E
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Address:
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Legal Description 15�i�r16 E�kAn , rr �1�. NV+
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Property Tax ID#:-�g-�a(o-boo " (� Lot No.
Site Plan Name: In— 1 I�.i'3 C 1--P-eY1 G7� Block No.
Project Name: C ( (a-IR- (��✓ P�Ir�G
Setbacks Front Back: Right Side: Left Side:
Aillortiona wor to e e ormeY underthispermit-c ec a apply:
OHVAC 0GasTank ❑Gas Piping ❑Windows/Doors
_Shutters
Electric LJPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.. of First Floor:
Cost of Construction: $ ill, 000 Utilities:]5ewer DSeptic Building Height:
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Name�G[�A ri r-eel-,/�r
Name: Justmmiery
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Address:Rucx) G agcE ty' T)✓ t
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Company: Island Kitchen and Bath
City--' pt' .PM State: �z
Address: 10875 S. Ocean Drive
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Zip Code: Fax:
City: Jensen Beach State: FL
PhoneNo�-Aq0(I
Zip Code:34957 Fax:
E-Mail:
Phone No. 772-237-7348 772-678-8219
Fill in fee simple Title Holder on next page ( if different
E-Mail: )thieryikb@gmail.com, nblaszkaikb@gmail.com
State or County License:. CBC1259508
from the Owner listed above)
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
,
SPPiEMEN AL GONSTRUC�TtON LtE tAUV tNFORMATtONwNVAM
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:JusbaThmary
Address:
Address:
City: State:
Zip: Phone
City: Jensen Beach State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: +0875s.ocean N No
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 Counttyy 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. lkou intend to obtain financing, consult with lender or an attorney before
commencinia work or recordihe vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatu a of Contractor/License Holder
STATE OF FLO A
STATE OF FLO DA
COUNTY OF ` �n.N,i,P
COUNTYOF
The forgoing inst ment was acknowledged before me
this � day of �( 20� by
The for oing instruf�, m was acknowledged before me
this IT day of r_ Au N_t 20'(by
a'lAd ree l\r=
�..cd 6V—e�cVN—'ram
Name of person making statement
Personally Known OR Produced Identificationt>L
Name of person aking statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced llli
L
Produced
(S�eofry Public- Stateof Florida)
(Signature of N ry Pu + i
ate of Florida )a�HAELRAAZ
C .'�M ComIpp0318620
` ExplresJUly28,2023
w1 •• °Ppe wTM �Wyeeldma
Commis ' n N
1YPLMICHAELRAAZ
r°: "'• al )Commiselon#GG31
July 28,20
j��For ow'* BaMaEPTMUSBW9e1NWvy
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
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Rev.8/2/17