HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTAL CONSTRUCTION L4EN LAW INFORM%aTl `N
i
DESIGNER/ENGINEER: _Not Applicable MORTGA13E 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: F 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 author* a the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaw 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 th t I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luci County Amendments.
The following building permit applications are exempt from undergoing a full oncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and E ccessory 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 mu t be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
commencing work or recording our Notice of Commencement.
l'
Signature of Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE O FLORIDA fn ,�
COUNTY OF ��q Kt l� COUNTY OF J"!a 1171
The forgoing instrum nt was acknowledged efore me The forgoing instrument was acknowledged before me
this�day of 20aby this�'( ay of /v 204 by
0 5 erg' 1�obe>T Am!✓✓D -5
Name of perso aking statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identih a ion Type of Identification
Produced / Produced L
(Signat (Signature o
' lip M0660064",
M=K ' 't�^°� ' MARK MELVINMY COMMCommis pi t: Commissi n tMYCOMMISSION#U�864EXPIRES =; A`.= EXPIRES:December 17,2021Bonded ihN ers `''&'F►t°`' Bonded ThN Notary PubIIC Undervrriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
LDATEED