HomeMy WebLinkAboutBuilding Permit Application (2)Mot
Name:
Address' State:
City -
Zip: Phone. ...�
FEE SMWPLE VATL% HOLDER.
Purine^
Andress:
CRY:
Zip: Phone:
— Not Applicable
P'JgOG3l7GAG E COMPARY:
Not Applicable
Name:
Address: State:
cKy,
lip: Phone:
OHMS COMP&DI'v, —Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County crakes no representation that is granting a permit will aut orize the permit holder to build the subject stn crura
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 dome 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 frorn undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residentlai use
WARNING TO OWNER: Youp ffajou m t@ nwaro a prl@4lea of �o�a��e��c�r<v�a�at�gn@W pa@ealt In Jqdror pav fg melee 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 uforio or recording your Matica of Corr mencement_
nature of Owner/ Lessee/Agent�—
STATE OF FLORODA
COUNrY Or-
r'
The forgoing instrument was acknowledged before me
this day of /—t c%1 fir, , 0 i '? i y
(Name of Fferson acknowledging)
s
aignatu of Contractor/License Holder
The forgoing instrument was acknowledged before me
this a I day of /-I Grc:. k . 20 1 -7 by
(Name of person acknowledging )
(Signature of Notary Public State of Florida } (Signature of Notary Public- State of Florida }
Personally Known
P oduced Identification
Type of ldentificatio
Pmduced
Commission No.
��+� MIKE (MARTIN
Notary f"_ otate of Florida
MANGROVE
d Commission N FF 216951
Revised 07/15/
'''•° ;� ++'' 8=W ttM* Neti&W Notary Assn.
Personally Known OR Produced Identification
Type of Identification Produced
"'.." +., (MARTIN
Commission No.
Neter - (trete of Florida
' _ •g Commission # FF 215961
Assn.
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
VEGI TATI0VA
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
WITIALS