HomeMy WebLinkAboutBuilding Permit Application (2) i
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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.
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 covenant's°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, consult withlender or an attorney before
commencing work.or recording our Notice of Commencement.
�e&A
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF •�+l .o
Theoing instrument was acknowledged before me The forgoing instrument wase acknowledged before me
forg
this�Lday of__-2VZZ0 20d— by this'L day of X26 20A7� by
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Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known I OR Produced Identification
Type of Identification Type of Identificati n
Produced Produced f-L Uki�
( " ature of NotaryPublic-State of Florida.) (Signature of Notary Public-Stat of F orida)
`LASH ANNA INGRAftiI j
Commission No. o�a� (Seal) Commission No. ! (Seal)
,otary PULu�- tate of Florida
my comm.'Expires Dec 20,2018
o`•'
Com Sion FF 177249 �" JGRA'
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'%,$;; BoadedtlNouq State
REVIEWS SUPERVISOR PLANS VEGETA I '��' ""'A' Public I 1 2018
,_ Ex 1'1VIAl� OtfE
COUNTER REVIEW REVIEW REVIEW REVIE __ *! .� � mtsst n�F Era Assn.
DATE %q>� F.o�'; gondedthtoug
RECEIVED
DATE
COMPLETED i
Rev.8/2/17
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