HomeMy WebLinkAboutBuildilng Permit Applicaiton Lr''' ,/ /,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: P. I 1 11,4 Permit Number: 10 0a— J C3---)
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. . -, , , , -
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, ,nsult with lender or an attorney before
commenc'• : work or recording your Notice of Commencem-
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Signature o O er/Lessee/Contractor as Agent for Owner Signature • i ontractor/License Holder
STATE OF FLO 'IDA STAT' OF LORI
COUNTY •F 6 f' LI ire COU •F 6I-, Lu Cie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisack\day of c /\c v ,20 let by this 25 obay of c3Th 11 / ,20,20M
10 .I Jo2Qa_ fay+tI / b/o zI -
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification/ Personally Known OR Produced Identification l/
Type of Identification • Type of Identification
Produced FL Lc Produced El b L--
(Signature of Notary Publi t-State o : ea) (Signature of Notary a of Florida
`i►Ar°ue'•: JORG AVARRO JR .4,0%._.,7!et. JORGE i NA RRO JR
Commission No. :o„��• �s�t'<I Commission No. _!` � Notary Public of Florida. �
,s,; ., Notary P blit tate of Florida $1 Commission#GG 227497
J a� P`• Commission a GG 227497 ''. dt
1 'hoc M cnm pAug ,or n;• My Comm.Expires Aug 10,2022
Y m.Expires Au 10.2022 Bonded through Nation Notary Assn. i
• Bended through National NotaryAssn. y
REVIEWS FRcThrr — — zvrvl}M� — �,W IW{ OR PLANS VEGETAT N— SrATURTLE— MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE 1
COMPLETED
ev.9/26/18