HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 (2' o!), )q. SCANNED Permit qi U
BY
RECEIVED
t y'` St. Lucie County
4
Building Permit Application OCT 2 12019
Planning and Development services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esl entia
PERMIT APPLICATION FOR: Window/door
Address:
Legal Description:
Property Tax ID #AS G a- ( o a \ ' 6\ ;n - C>00 Lot No.
Site Plan Name: i . --1 O Block No.
Project Name:W'f_l0 1 PN1 1 t 2
Setbacks Front Back: Right Side: Left Side:
W \(k44
HVAC " Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Piping IJ Shutters
Generator "Roof
S Ft. of First Floor: _
Utilities: Sewer E]Septic
Building Height:
Roof pitch
dWN6 LE SE _ F i tF. <"
CfJN-A&OR
Name,)D)jy�
Name: JustinThiery
AddresscAis'50 S•
Company: Island Kitchen and Bath
city: ttk-\A;' L? _Q one State: l
Zip Code:,�llj } Fax:
Phone No."1'1a-2DI�'l-Ci59q
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code:34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail:— e) I C'_
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
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name: Justn rhiery
Address:
Address:
City:
State:
City: Jensen Beach
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address: 1e875 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 your Notice of Commencement.
Lessee/Contractor as Agent for
STATMF FLORIDA
COUNTY OF sc Luae
The forgoing instrument was acknowledged before me
this (1 day ofSv��t y 1 - 120� by
'VY
VAS
Name of person making statement
Personally Known OR Produced Identification x
Type of Identification
Produced Drivers License
E/I
(Signature of Nota li ate of Florida )
MICHf�V
Commis ' n _, fflj1longGG310828
♦ ExpltesJuly28,2028
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8
REVIEWS I FRONT ZONING
COUNTER I REVIEW
DATE
I COMPLETED
Rev.8/2/17
STATE OF FLORIDA
COUNTY OF st wde
The forgoing ins ument was acknowledged before me
this�dayo 20�'3 by
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced
(Signature o ary�Publlc-St8teFlorida )Com fission No.+rjtYe,�a�,Seal) MICHAELRAAZ
tr•„n,m�eew.nrr as
Explros July 28,
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