HomeMy WebLinkAboutBuilding Permit Application (2) ' i_. `v: •.�.•$�.: . "a'.'G.„ tr" �. r .. 1
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
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Name: - mime.... ..
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.LucieCountymakes no representation that is granting a permit.v:%I!.authorize the permit holder to build the subject structure
which is in.conflict with.any applicablefHome Owners Association rules,bylaws or andcovenantsthat 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 heieby 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
commencin• work or recordi,: our Notice of Commencement. . . I
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ignatur.-,/Owner/'esse'/Contract.r as . .ent for Owner , Signature of Contractor/License Holder .
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STATE OF FLORID . . : .STATE OF:FLORIDA,
COUNTY OF � `Lv C0 COUNTY OF. �/Z 0 `l.Vk
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ct1'r. I ,20 i by . this 075 day of SSU of ,20 by
l;,S 10► Sca g.,° -C, ' r in '3v.t ec MA-r'skek.t,l
(Name of pe -: acknowl .: g) (Name of person acknowledging)
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�' .rte 01,* /1 f '
gnatur- of-otary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V Personally Known. OE PLod cgd Identification
Type of Iden ification Type of Identification 0 to
::::
1r ' Joshua Jacobo-G u .O.-CGCS Q z o � STATE OF FLOR yJon No. 57Zi.t:, �o mission No: '
�+G!„ • Comm#GG1572 92.. 1 �-_�u a My Cor{1i'1�• Irn Jan 1,2021
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. . . `"4ci 05 Expires 11/1/2021 •;� -_ _ _NiIIgnMNolryAun.
REVIEWS FRONT ZONING SUPERVISOR PLANS .. VEGETATION SEA TURTLE • MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . ' REVIEW- REVIEW
DATE
RECEIVED
DATE
COMPLETED
'ev.7/2014
4:1:- /ern It-f- /Yozi-oeso
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