HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
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FEE SIMPLE TITLE HOLDER Not Applicable BONDING COMPANY: Not Applicable`
Name: Name:
Address: Address:
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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 authorize the ppermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and-covenants that mayrestrict 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
commencin work or recgrdingypur Notice of Commencement.
�, &V.lit
Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE.OF FLORIDA STATE OF FLORIDA
COUNTY OF ' ,(�� COUNTY OF
The forgoing instrutnnent was acknowledge efore me The forgoing instrument was acknowledged before me
this4odayof JfiN
___,.20-0 by this day of 20_ by,
Name of person,making statement. / Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide of ation Type of Identification
Produced Produced
(Signature of Notary Pu lic-State of F orida (Signature of Notary Public-State of Florida)
Commission No. �.;;l"yP"%, KAR N NI:LSN
State oft 1 W a-Noblic Commission No. (Seal)
:Commission#G84M Commissiones
June
2, 401
REVIEWS FR -SUPERVISOR PLANS VEGETATION - SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
. DATE
COMPLETED
ev.