HomeMy WebLinkAboutBuilding Permit Application (2) SU PLEMENTAL CQNSTR� CT{a'N]IIIN LAIN 1 FQRM TION:
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
comme cing work or ya-qNing your Notice of Commencement.
ignature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licen Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a ; COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day oftT ,s2 20� by this day of 2 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat' n Type of Identification
Produced pl Produced
(Signs ure f Notary Public-State of Florid (Signature of Notary Public-State of Florid)
Commission No. _..,,.. $GRAM-RAMMING Commission No. �-,•� ,.�.. �$p I
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REVIEWS FRO", NOW PLANS VEGETATI '•'.F : �i4g� N�3=E
COUP%%• REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17