HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: _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.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 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
commencing work or recording our Notice of Commencement.
Sign ure of Owner/Lessee/Contractor as Ag Fiv r SignaturiS of Contractor/L-icense Holder.
STATE OF FLORIDA i m < STATE OF FLORID a Xc,a
COUNTY OF .�o COUNTY OF z��
cl mE o u�u,
The forgoing instrument was acknowledged be = The forgoing instrument was acknowledged befo z
this da of 20/ V z
y b Ta this IL day of 204 by
co
7e of person ma ing statement. Na e f person making statement.
ersonally Known - OR Produced Identification`s Personally Known OR Produced.Identification
Type of I l�etr• c tion Type of Iden•1 ica• n
Produced- Produced UriC,•
(Signature of ar'Public-State of Flori V (Signature of Notaryblic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.8/2/17