HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
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:
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, con
commenci ork or recordingour Notice of Commencement.sulth lender or an attorney before
gnature of Owner/Lessee/Contractor as Agent for Owner eignature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF V COUNTY OF �i ��/ LL
The f oing instru nt was acknowledged before me The fgr
Zoing instruffNnt was acknowledged before me
this day of 2 by this day of 20�y
'Vy b b_V
Name of person making stat ent. Name of person making stat ment.
Personally Known rsonally Known produced hd1mAYISACAon
Type of Identification DAWN MILONE pe of Identification = = My COMMISSION 0 GG 0499
MY COMMISSION*GG 04999E ME EXPIRES:March 2Z•2021
Produced :: oduced °•
EXPIRES:March 2Z 2o21 c: Nowy PLft Urderwrrltars
` ''••,p•,•; Bonded Th-Notary Pubpc
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of FloridaJ )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17