HomeMy WebLinkAboutBuilding Permit Application (2)yU P ! Q
Not Applicable MORTGAGE COMPANY: Not Applicable f
Name: Name:
Address:
Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY; Not Applicable
Name:_
Address:
may:
Phone:
OWNER/ CONTRACTOR AFFIDVLT: 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 restriction 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 Budding 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, wails, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OVIINEIL YOUR FAILURE TO RECORD A 'NOTICE OF C0- 1131110ENENT MAY RESULT IN YOUR PAYING
TRICE FOR INPIROVENENTS, TO YOUR PROPERTY. A NOTICE OF 01 MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. F YOU INTEND TO OBTAM FNAMCIiI C, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORaI1G YOUR NOTICE OF b
Signature of Owner/ Lessee/Contractor as Agent for Owner
SPATE OF FLORIDA
COUNTY OF
The fing instrwrie t was acknowledged before me
thisday of 2o_Lq by
!Name of person making statement.
Personally Known OR Produced Identification V✓
Type of ldentifcation K i-*5 -(dc .3 ` + `j ._ � �� f
Produced ri- yr
_. 0ENDOLYN I. BELL
MY OM ISSION # GG 170551
W: December 25, 2021
Bonded Thru Notary Public Underwriters
i
Signature of Contractor/License Holder
i°
STATE OF FLORIDA
COUNTY OF n e
The forgoing instrument was acknowledged before me
this 3 day of October 2o_i�L by
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
1 DATE
r 4 {
RECEIVED
I DATE
COMPLETED
Y
Rev. 2/7119