HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: I —
ry BY
a St. Lucie County RECEIVED
Building Permit Application NOV 2 2 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Renovation
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Legal Description: Sr�G(ir (�Cr�l]l�rY� v �w i/LVl�1 }C�
Property Tax ID #:45C);) -Ci.,GG - Lot No.
Site Plan Name: ICI Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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�rtio wor to e e orme un ert ispermit—c ec a apply:
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❑Gas Piping _Shutters ❑Windows/Doors
_ Electric LJ Plumbing Sprinklers O Generator 1-:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Z2>I utilities: Sewer ElSeptic Building Height:
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Name
Name: JusunThiery
Addressr'Lr-9. O
Company: Island Kitchen and Bath
City:. )t y2ser, State: _E�
Address: 10875 S. Ocean Drive
City: Jensen Beach State: FL
Zip Coder Fax:
Phone No.9 —1'1 }114
Zip Code: 34957 Fax:
E-Mail: v=l c
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.
DESIGNE ENGINEER:
_ Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
_
Name:i-tin im
Address:
Address:
City:
State: City: iewnll6 State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address: +M7sS.Om Dare
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
commencine work or recording vour Notice of Commencement.
Signature of OwnRer/ Lessee/Contractor as Agent for Owner
S' nAoactor/License Holder
STAE OF
OJ'rA (
STF
COUTNTY OF A n P�t� C
A /-C (-e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 10 day of Gc-tn 20L by
this l U day of 0_-tir>6 2011 by
I-AnC Nnin-, ,,��-,r n—� r.
"_ t Y, Tir„
Name of person making statement
Name of person mak4tWstatement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nota db� S at to of Florida)
(Signature of Notary Publ' of'Florida )
fe
Commis! io n (Seal)
MICHAELRAAZ
Commission Yvu Mi HAELRA4eal)
COmmisslon80001M
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Ccmmissicn It GG 316620
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L>iesJuly 26,2023
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REVIEWS
FRONT
ONI�p°m"
Vs OR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
11 Rev.8/2/17