HomeMy WebLinkAboutBuilding Permit Application Page 2 "DMESIGNPENGINEER: Not App#icable MORTGAGE COMPANY: Not Applicable
Name:=- Name:.
Address: Address:
City: State: City: —State:
Zip: Phone tip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name.
Address: Address:
City' City:--
Zip:
itytip: 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.
Si.Lucie Coln makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con with arrtyry 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 l 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 firstin ection.If you intend to obtain financing,consult with lender or an attom y before
commencin w or recordinit Your Notice of Commencement.
/////,// 1117
Sign ofrA
/Co ora ent for Owner Snature f on cense N er
ST E OF ORSTAT FL D
C LINTY OF V� COU OF .�.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this r day of 20 I7 by this T day of 0--t- 201-7 by
rmnkk 849y ON[$ c Bafty
Name of person making statement Flame of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of identification
Produced Produced
C�_ ,l 111-17 C�7_4 '4
(Signature of Notary P ic- a of orida) (Signature of N ry P Stu of Florida y
Commission No. ' ►TAL.Y BISHOP mmission No.GG12M 4*k*. CRYW Y BISHOP
" MY CCMAM R510N*QG127 8 `c My coMLtSSION 0 00127618
EXPIRES A*/2-4,2021 EMPIRES July 24,2021
REVIEWS FRONT ZONING SUPERVISOR PLAINS VEGETATION SEA TURTLE MANGRC?VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/27