HomeMy WebLinkAboutBuilding Permit Application " I
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,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: 1` Not Applicable
Name: Name:
'Address: Address:
City: State: City: i. State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: e—Not Applicable BONDING COMPANY: i' Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: I
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do th6 work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
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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 covenantslthat 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.
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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 attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lice'rise Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF W a.(+I r) COUNTY OF M OL(h!�
The f rgping instrument was acknowledged before me The for mg instr ment wa I'acknowledged before me
this-3
day of 20 IS by this 07 day of a9. f 201 by
Name of person aking statement Name of person-making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produc d I'
�44A�
ignature of Notary Public-State of Florida) Agnature of Notary Public'-'State f Florida) EHAWNA DOE
2 SHAW NA M.H DOE. I' NOTARY PU
Commission No.FI= �31S�3(a NOTARYPU ��mmission No.FF i 3M34
STATE OF IDA
STATE OF ORIDA I Comrr#FF1
. Caox*FF1 838 �° 18
Expin a 6/ X18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE j
RECEIVED I
DATE
COMPLETED
Rev.8/2/17
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