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ALL'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 Cj �� Permit Number: Ill /
Building Permit Application RECEIVES
Planning and Development Services JAN p52019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST, ucieC u ty, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Renovation
Address:,:::,_90O S. GCEt'—c-, Nr W-N-.4 Ao
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Legal Description:C `C_oa _e_- (o�� Q^ .;r r� ,�r�� T{- (n, �,-1
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Property Tax ID#:-45&a-c5C1?,- 0134-noo-u, Lot No.
Site Plan Name: (701a— C3\A\, o C Block No.
Project Name:�(j(�la-\n��05
Setbacks Front Back: Right Side: Left Side:
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ICON T121Ci�QN INFORIfiON_� hey
Additional wor tc�e�e�orme undert lspermrt-c•ec a apply:
0 Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
nnOHVAC
Electric Q Plumbing ❑Sprinklers 11 Generator � R iof Roof pitch
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Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ l l l CiAL+ - - Utilities:[]Sewer Li Septic Building Height:
dWl%fISSEE'•R ' �ON�R1Ctt
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Name 1 I
Name: Justin Thiery
Address:q Cj0 ^� . G2Gr� DJ A-14 Q'2
Company: Island Kitchen and Bath
CitY;' 0A ,Goys, GicaEa +-% State:rz_
Address: 10875 S. Ocean Drive j
Zip Code:35-?- Fax:
City: Jensen Beach State: FL
Phone No.TSiOG -Atr$'-(DCI'3a
Zip Code: 34957 Fax:
E-Mail: )C)CNCh c to 1�Se
Phone No. 772 878-8219 - 772-237-7348
Fill in fee simple Title Holder on next page (if different
E-Mail: jthieryikb@gmail.com; nblaszkaikb@gmail.com
from the Owner listed above)
State or County License: CBC1259508
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:JustinThlen
_ Not Applicable
Address:
_
Address:
City:
Zip: Phone
State:
City: Jensen era
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
f _Not Applicable
Add Tess: +eels S. o� owe
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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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 bIuild the subject structure
which is in conflict with any applicable Home Owners Assu cation 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,
accessary 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. I
Slgn ure of new/ Lessee/Contractor as Agent for Owner
cure of Contractor/Li r{
Holder
STATE O F IDA
STATE OF FLORIDA
COUNTY F st was
COUNTY OF st
The forgoing instrument was acknowledged before me
The forgoing instrument was
acknowledged before me
this � day of I ,Prw--n1�. •� . 20_6by
this C day of �cA� rnh :-, 20-D by
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9_A1C 1-re} I _ LZ I I
Jusbn TNery
Name of pemdn making statement
Name of person making statement
Personally Known OR Produced Identification x
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced Drivers ucense
Produced
(Signature of No.ta
(Signat
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REVIEWS
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SUPERVISOR
PLANS ,
VEGETATION
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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Hev.B/2/17