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HomeMy WebLinkAboutPermit App pg2 - RodriguezDESIGNER/ENGINEER: SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: MORTGAGE COMPANY: Not Applicable Name: rTA RIDACOUNTY Name; Address: OF 7N Address: City: State: City: State: Zip: Phone this lam_ day of ►� ' 0-1 1 20„� by Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Personally Known OR Produced I entification Name: �- N Address: Type of Identification Address: City: Produced JL City: Zip: Phone: Zip: Phone: � y La E (Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida) 0 " z OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. on No. (Seal) I certify that no work or installation has commenced prior to the issuance of a permit. , � AtdDREALATj9714M 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 such prohibit 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 WM JW SS 2t 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, FRONT 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 VEGETATION improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite nnm MANGROVE before the first inspection. If you intend to obtain financing, consult wit er or an attorney before commencingwork or recordingour Notice of Commencement. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED o� Rev. 8/2/17 DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: rTA RIDACOUNTY Name; Address: OF 7N Address: City: State: City: State: Zip: Phone this lam_ day of ►� ' 0-1 1 20„� by Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Personally Known OR Produced I entification Name: �- N Address: Type of Identification Address: City: Produced JL City: Zip: Phone: Zip: Phone: 4 Signature of Owner/ Lessee/Contr as Agent for Owner ura icense H I r STATE OF FLORIDA rTA RIDACOUNTY OF 7N F - (�'('- \"P— � The forgoing instrument was acknowledged before me The The forgoing instrun �ant was acknowledged before me this � day of (�� G� 20 a by this lam_ day of ►� ' 0-1 1 20„� by Name of person making stateme Name of person making statement .20 Personally Known OR Produced I entification Personally Known OR Produced Identification �- N Type of Identificatipn . Type of Identification o LL Produced �i k A - Produced JL LLJ � y La E (Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida) 0 " z © Commission No. ! � l �'Z© �.•'t�`: on No. (Seal) � r , � AtdDREALATj9714M =� M`f COfNMiS310N t � WM JW SS 2t REVIEWS FRONT VEGETATION SEA TURTLE nnm MANGROVE ZONING COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED