HomeMy WebLinkAboutBuilding Permit Application (2) {i..<,-.t'A:} .. j��l-.�.�'5� _ ��"�''_.,, s3'' S 'Y' ski„.i'z, .a•m y y �,�sc. �;.. ,r���T��'"�;„�zµ!�yari�`�5"��_�, zf���' s,' '�
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:
'I City: City:
Zip: Phone: Zip: Phone:
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 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 with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent re o ontractor/License Holder
STATE OF FLOOR STATE OF FLOR A�
COUNTY OF� COUNTY OF Gi+[ PGi
The forgoing instruent as acknowledged before me The forgoing instru�ent w s a� cknowledged-before me
hi �. day of V 20by this� day of �! � 20by
_J0 Pylcz� c) Q4 V7
M rso c wIedgIng) (Name of person acknowledging
(Sign r of NotaryuP blic-State of Florida) (Signature otary Pd6lic- to of Florida)
Personally Known0 Pr d I n 'fica ion �I" Personally Known �OR Produced Identification
Type a ion ro fig$ e,e ti Type of Identification Produced
.�io` YpLe�% Notary Public-State of Florida (Seal)
Co FF 199846eal Commission No. ,���e {se
c s r �o�,:••.. �� ANGEl.AYOUNG
My Comm.Expires Feb 15,2019 . MY COMMISSION k FF 951089
Befidedihmu
EXPIRES:Aad1 12.20_0
FOF Flo Bended Thr BudG-t Nola-Scr,,ces
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS