HomeMy WebLinkAboutBuilding Permit Application All APPL[CA8 Fp'MUST BE:COMPIETED FUR`APPMATioN 70;BE ACCOTED
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Building.Permit Application
, Planning and I)eveTopmeni5enirces •
Buildiho and Gode Regu1dtl6n D!V!iion
2300'Wrginla`A,Venue,.Fort Pierce FL;34982
Phone:�(772)462-1553 Fax (772}462-1578 commercial . Residerrtial . .
PERMITAPPLWATION FOR:•
`1 3. C vs Q Pf Ltq51Address: *
Legal.Die e�iptiori LaYt W6 'C�h• _( as
taQ _ .
Proper`tyTax iD#: l 3 L '. � � - Lot No
Slte.Plan Name::. __ _ Black Nm
/ w
Project Name L• du l(�f
$e6pglq Front . Back: ;Right Side t efk Side::
h S
iona work to be nertormed under t js. er..mi c„'ec a. that a .
`Methdn'Ica Abas7ank _GasiPiping _.,,Shutters WindOWsf Doors.
Electric. _Plumbing Sprinklers _;Generator Roof' Pitch'
Total S* koftbristructiona, _ Sq.Ft of:First Fioor: _.
7J [ltilittes;' _Sewer Septic. '$uildI4oMeight::.
Ctstof`Canstruction:$ ._ , . .
Name. tvame. o krlA:Z
Address:: '�>. 3 _ Company: :G� c
:'eeac e. state YL Address °I: l� of _ ( ,v lt� 1
Zip Code: QJ1 a" Q_ City Gi:Q Stafie1
Phone No Ztp.Code f Fax
E-1Viail: ...:, Phone N lq-e>-3A 3�:R,
0
Fiil.in:fee simple.Title Holder on-next page(,�f different E=Mail u121ftri e e .� a i ..C.om.
from the Owner listed above) _State or County nse LiceaC A '1 63
{fwalye of canstn ctiorris 2'SOd or moke,,a.RECORDED:Notio6 Cae tmencernent isreguired.
DESIGNER ENGINEER; _.Not Applicable MORTGAGE:COMPANY: _Not Applicable
Warne: Name:
Address: Address: .
'City State: City: State:
Zip: Phone Zlpc Phone:
FEE SIMPLETITLE HOLDER: Not'Applicable BANDING COMRANY _Not.Applicable
Name:. Name:
Address . Address:
City: _ City:
Zip: .Phor%e: Zip: __ . _. _ _Phone:. _
OWNERf',CONTRACTOR AFFiDViT Application is fiereby madeto obtain'a'pemiitfo do the`wark and installation.asIndicated:
l eertify that-no work:orinstallation has commenced:prior to:the:issuance.ofIa pennII.L
-St.Lucie.Counttyy makes no`represebtation that'is granting a.permit will:authorire the ermit,fiolder to build the subject structure
which is m confiictwith any applicable Horne 0wners:Association rules;'bylaws-or andcovenants that may restrict:or,proibtt such
striicture.Pieas60risult with your Home Qwnertlksociatiarrand`review youe'deed for-'any restrictions=which may apply:
In consideration-of_the.granting;of this requested permit;.l do�hereby agree that i will,in respects,peiforrn th'e.work
in accordance-with the approVed,plans;the:Florida Building Codes.and:St,Lucie,,County Amendments.
The following:building-permitapplications are�exempt from•undergoing a.fullconcurrency-review:room-additions;
ry accesso structures,swimming pools,fences,walls,signs,screen rooms and:accessory-uses to,another non-resldentlal.use
WARNl[_WTO OWNER:Your failure to.Record.a Notice of Commencement may result in your paying tvAce for
Improvements to.your property:A Natite.6f Commencement must be recorded:and=.posted,oh:the ibbtito,
before th,Offrst`inspectian if yoU intend to obtain financing,,consult.w th lender or an.attomeybefore.
eommencin` work or recordin our Notice of Commencement..
Si nature
g ner/' see/Contractor asAgent;forOwner Signa com_ ;_. r/LicenseHolder
STATE OF FLORID - STATE OF FLORIDA
COUNTY lF
The forgoing-lost_' en#was:acknowledged:before me Thefor oing'instrent s:aeknowledged'before me
this tlay'of . 20�, by this dayof': 20
JJIA_4 .: W 2LU p
(Name.ofperson-ac owledging) (Name of person-acknowIe grog)
signature of.TTo 'Publjt-,Statelvf Florida) (Signature of,, c " :Public- tate of Florida;)
Personally,Known 1/ 0R.Produced identification 'Personailyxnown- OR'Produced identification
Tjipe.of identification Type of Identification
Produced r Produced �,nrp„ RiIN
A LYNN OKSMAN DA LYNN OKSMAN
mY cod 18SiON i FF 061691 y01FIF
*,myc o1u 11410N AFF 061691'
"comrnlssionMo. * * commission No: EX S Bl�ebtua 16,2018
• EXPIR 6ary•16,20le ry;
grEany�� EXPI Thni6udgetNofary$ervlr�s Bonded:iluirB'udge'NwryS;Ici,
'REVIEWS FRONT ZONING SUPERViSQR PLANS VEGETATION SEA TURTLE MANGRQVE.
COUNTER REVIEW REViEW REVIEW REVIEW 1tE1%IEW REVIEW.
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DATE .tS
RECEIVED. _
DATE ry..
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