HomeMy WebLinkAboutBuilding Permit Application (2) StJ' L OMENTA [TO NST" UJCTION LIEN LAW INORMATIQ ;
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., 1'=
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.
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Signature of Own /Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA. i STATE OF FLORIDA
COUNTY OF�� ; ��, COUNTY OF Luc, iE2
The for ing instr ment was acknowledge efore me The for ing instru ent was acknowledge efore me
thisday of 20by this day of 20by
(Name of person acknowledging) (Name of person acknowledging)
1
(Signature of Notary Pu lic-State of Florida ) (Signature of Notary Public-.,S6ieo Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification Y
Type of Identif 'on Type of Identificati
Produced N S. NIELSEN Produced
State of Florida Notary Public ;os °' AREN S. NIEL-SE N
Commission No. Commi ����# GG 207484 =* {_Stat�of.Forida-Notary Pubic
My TO,NMI Expires Commission NO. ,r oPc Co ion #GG
207484
June 12; 2[122 ''.�oF��.o� My Commission Ex
June 12, 2022pires
REVIEWS FRONT ZONING- SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2-014