HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /��}
Date: SCANNED Permit Number: 1 I ��'
St. Luce County RECEIVED � 11019
Building Permit Application ncT a
Planning and Development Services ttim9
amen
Building and Code Regulation Division Ner 5Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renovation III
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Address:C�A66JC7 S OCQe1
Legal Description -Se PrMC'Ps0-(7 [Av- +503
Property Tax ID # CiCJa — 1p 1 O - t�043- CLOG Lot No.
Site Plan Name: III I�X) -
Project Name: l`' 1 1 , )l , J Z
Setbacks Front Back:
M&S'�
Right Side: Left Side:
Block No.
itiona wor to e e orme un i r t i permit- c ec a app y:
OHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
gElectric L"J Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction:p S Ft. of First Floor:
Cost of Construction: $ /, 0-� Utilities:nSewer 0 Septic Building Height:
Roof pitch
OWNER/LKS,',,,S,
-Name
'CONTRAIsTQR
a- A,AA
Name: Justin Thiery
Address:
Company: Island Kitchen and Bath
City: a�.Q Q�&c -C1-, State: S�_
Zip Code: Fax:
Phone No. ]`�Ab —:5r5V - U 34o
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. 772-678-8219 - 772-237-7348
E-Mail: n0
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: jthieryikb@gmaii.com; nblaszkaikb@gmaii.com
State or County License: CBC1259508
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
St1PPLENIENTAL CONSTRU'CTIOIV
* 9A!'aHdkwI
L{EN$LAW INA(�/�ATION
,
aSP
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name- Justin Thiery
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City: Jensen Beech
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
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 Commencement.
X Q �
Signatur of Ow / L ee Contrr
actor as Agent for Owner
if STATE OF FLORIDA
COUNTY OF sL wde
The forgoing instrument was acknowledged before me
this�dayof (2)C7JD\ZAI .20101 by
NaIIle of person making statement
Personally Known OR Produced Identification�X,
Type of Identification
Prnrlllcrrl Drivers License
(Signature of Nota ub ' - State of Florida )
4�a RAAZ
Commission No.. u rr p eso frGG318620
®* F.101resJuly28,2023
REVIEWS I FRONT � COU TER REEVIEW SUPERVISORNING REVIEW
RECEIVED
COMPLETED
Rev.8/2/17
Sig tur of= tra or/License Holder
STATE OF IDA
COUNTY OF sc wde
The forgoing instrument was acknowledged before me
this_11dayof20,L by
Tustin Thiery
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
(Signature of Nota ic- ate of Florida
' )
Commis n q,0%V.PVeal) MICHAELRAAZ
CommisslonR00318
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