HomeMy WebLinkAboutBuilding Permit Application (2)FE:
SUPPLEMENIALLUNSIRUC IION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address: j
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
is in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict
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 attomey before
commencing work or recqfding your Notice of Commencement.
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Signature of Owner essee/Contractor as Agent for Owner
Signature of Contraclortl icense Holder
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF U e l E'_
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Z b day of c,APW 20 / •7 by
this 26 day of20 17 by
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(Name of person acknowledging }
(Name of person acknowledging) j
(Signature of Notary Public- State of Aa }
(Signature of Notary Public- Stat of Flor
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Identification
Personally Known ✓ OR Produced Identification
Personally Known OR Produced
Type of Identification Produced
Type of Identification Produced 1
Commission No. U 6 0 5� � 116 a4'<,, CWJsTW98
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR j
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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