HomeMy WebLinkAboutBuilding Permit Application (2) UFFLE ENTAL C«INSTRUCTION LIEN LAW INfURMA ION:
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.
licertify 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
i i 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
gel ARNING 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
i WITH MR LE 111JW AN#TTORNEY BEFORE RECORDING OUR NOTICE OF MMENCEMENT."
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.Sig ture of Owner/Lessee/Contractor as Agent for Owner 4Signai4eof Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID X e
OF,COUNTY \ COUNTY OF �c .
1 ,
The or ping instrument was acknowledged before me
The forgoing instrument was acknowlecig d before me this day of 20a by
thisOMday of 2N by M� f'
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced
Type of Identification
Produced
ignature of Notary Public- tate of Florida )
Agn tur of Notary Public- ate of Florida) Commission "
;Commission No. — MY COMMISSION#GG275060
Y� a•; LASHAHNAINGRAM-RAHMING 'o` EXPIRES:December'20,2022
' MY COMMISSION#GG 275060 '�Fud�;:°Q' Bonded hru Notary Public Undentrriters
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Y=, -W.: EXPIRES:Dece e
REVIEWS F `•"." •tart' u li e PLANS VEGETATION SEATURTLE MANGROVE
CO REV�I�EW REVIEW REVIEW REVIEW REVIEW REVIEW
,DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19
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