HomeMy WebLinkAboutBuilding Permit Application (2) c
SOPPLEMENTAL" CONSTRO.CTION'-LIEN LAW-.INFORMAL')QN-,__,�, h r:
DESIGNER/ENGINEER: _Not Applicable MORTG GE 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 obta in a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of permit.
St.Lucie County makes no representation that is granting a permit will autho ize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,byla s or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review yor deed for any restrictions which may apply.
In consideration of the granting of this requested,permit, I do hereby agree t at I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lu ie 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 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 must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, con ult with lender or an attorney before
commencingwork or recordingour Notice of Commencement.
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Signature of Owner/Lesse Contractor as Agent for Owner Signatur of Con actor License Holder
STATE OF FLORIDA STATE F FLORIDA
COUNTY OF COUN OF
The f oing ins ent was acknowledge before me The forg ing instr ent was acknowledged before me
this ' day of 201by this day of 20 by
Name of person making statement 4ame&person making statement
Personally Known OR Produced Identification Personal)I Known OR Produced Identification
Type of Identification Type of h lentification
Produced Produced
r*0.�_�.
i n re ki Notary Public-State of FI ida) (Si atu a of Notary Public-State oJ Florida)
c nu��4INGRAM R•�,a,�-�,
Commission No. I """��. LA`tSea�') Commiss on No. LASH AF(Seal)RAM
oa #�; Notary Public-State of Florida -
* .`My Comm.Exp'sres Dec 20,2018 2w�`, _ Notary Public State of Florida
fission?{ FF 177249 '• 4�i =My Comm.Expires Dec 20,201 S
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tional Notary ASM ,,;, �, 1 „ m 712
bonded through N. oFOFF��.�` e n �atior I t�ntary As
REVIEWS FNAT, -ZONING3 _-SUPER OR PLANS VEG � ThL€ MAIyGc. E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
.RECEIVED
DATE
COMPLETED
Rev.8/2/17