HomeMy WebLinkAboutBuilding Permit Application (2) i
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
-City:
Zip: Phone Zip: 'Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Nam -Name:-
Address:
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 forany 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 attorney before
cornmencing work orrecording your Notice of Commencement.
gnat a of er/Lessee/Contractor as Agent for Owner Si ature f ractor/License Holder
STA E OF FLORIDA STATE OF FLORID
COUNTY OF 6)-r. L COUNTY OF .cs xiwllof-
The forgoing instrument was acknowledgel before me The forgoing instrument was acknowledged before me
thisi�day of `l`�4 l 20 by_ this S' day of /9v6,vcr7— ; ,20/7 by
�a�r S� ag� c��i-� S •ri4At3 !
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification •�
Type of Ide tfication Type of Identification
Produced Produced
i
(Signature of Notary P lic-S igna of ate of� ��T�It,l7d8
MI NNA MARIE GplENS + t
Commission No. myCO&D ON#GG O? Commission N" missiah(�9pes 0319/2018
'* ~' EXPIRES:Dere
M �R R1
> oe' Bonded Thru Notary P-Jule Urcie wrt .; rdammielan NA �F 103713
F
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ;' SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW '
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17