HomeMy WebLinkAboutBuilding Permit Application I
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:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: _
-Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 i
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"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BE RE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEN O RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractoylicense 6folder
STATE OF FLORIDA STATE OF FLORIDA 1
COUNTY OF rail L Gr�-COUNTY OF (oI,� �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2_0 day of RU& 20L9_ by this day of U 1, 20�fi by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identifications/ Personally Known L-"— OR Produced Identification
Type of Identification Type of Identification
Produced C,45Q-5S5-(v2-28(v O Produced
9 SE—
(Signature of Notary Public-St - )Notary Public-State of •I4+jg ture of Not u ic-State-of Florida)
r »•= Commission # FF 99 66B pa�'v."�� SUSAN GORDARD
Commission No. r S�19 » ' 8d�Comm.Expires Jun 1 ,Q®Mfission No. r`r9`� °����- otter �� d
y Publl a of Flori a
Bonded through National Nol ry Assn. _• Commission M GG 033219My Comm.Expi1
' "�����•`�• Bonded throw h Natio al t r
REVIEWS FRONT ZONING SUPERVISOR PLANS VI VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.