HomeMy WebLinkAboutBuilding Permit Application (2) Em
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: _ State:
Zip: Phone Zip: Phre: ., 2 0 ,
,e
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPA Not:4,41ica le
Name' Name: ST. Lucie oun y, Peng
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU 1 D TO OBTAIN FINANCING, CONSULT
WITH YOURAENDEOR AN ATTORNEY BEFORE RECO INGJYM NOXICE OF COMMENCEMENT."
Signature of Owner/ essee/Contractor as Agent for Owner Signature ofC tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF it t l) COUNTY OF St. LUc.w
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this X7 day of 20A by this_9 day ofd sf- ---,26-Lf by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(S Aaturi t P -St&g af Werida (Sign re of No FI rida) _
AANETTETFIOMMON �,o`s" Yp%j�,� JEANETTE 0 SON
Commission No.11tNotary PubtidSd�i)e o1 florlda Commission No. :a� �? Notary Public� �
F Florida.
Cbmmisslon GG 031064 • Commissiondr GG 037064
Comm.Ex fres Oct 14 X20 Banded through Nation Notary Assn. Bonded throu h
Na'onai
REVIEWS OR PLANS VE G 1 i a r OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE I
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19