HomeMy WebLinkAboutBuilding Permit Application (2) Apr.18.2018 09:33 AM DE LA HOZ BUILDERS INC. 7725898127 PAGE. 2/ 3
j
#P A11110 lei
i_ ISH
M
41 0'1,qp�
DESIGNER ENGIN E9111: x 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.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lude Cour makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which Is In conflict with an a
,upplicable Home Owners Association rules,bylaws r and covenants that may,re trict or prohibit such
structure.Please consult wt Your Home Owners Association and review y 9 or any restrictions WhA 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,slgn5,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Yo failure to Record a Notice of Commencement may result In your paying twice for
-K.Yo Tallure
P uwNr
improvements to yo roper A Notice of Commencement must be.r%,�&�e � posted on the jobsite
' 0 1
before the first In ection. Ifyo tend to obtain financing,consul lend attorney before
I I �1�
commencing Wpfj� r recon r Notice of Commencement.
—
Signature see/C as ent for owner Signature of Con e of r
na
STATE OF=FLORIDA ' STATE OF FLORIDA
COUNTY OF—_._._ illa COUNTY OF
The f rgoing InstrumWtwas acknowledged before me The olng lnstrumenwas acknowledged before me
this f toy
L day of LW,?n 2QL by this_day of AI;V? 204 by
Name of persxmaking statement Name of per making statement
Personally Known L/ OR Produced Identification Personally Known OR Produced Identification
Type of identification Type of Identification
Produced Produced
IJI
LSnat_urg*Mtf-a-�C.State of Flor (Signa re of ry ate of Florl KoM JNM
n'anm C PUS
in
P U NO-rARY
STATE
OF U13 I STATa OF F R A
Commission No,. STATE FLOE 11SAmmissiOn No.
Fr247011 Cumm#FF241 I
R
or
U FZ41
Exp
area 70200
9
Expires 7/612
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev,8/Z/17 P6 2 M-LIr I ro 0 qr_3