HomeMy WebLinkAboutSLC building permit application 2 10-8-19SUPPLEMENTAL C'NSiRUG '10N 11, N LA' 1"' II FORMAT' 10N;
DESIGNER/ENGINEER: _ _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable j
Name:
Address:
Address: 3
City:
City: I
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 SLTE BEFORE THE FIRST INSPECTION. IF. YOU INTEND TO OBTAIN FINANCING, CONSULT
WiTtt YOUR LENDER OWAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
5igriat0i�C.of Owner see/Ce:ntractor as Agent for Owner
Signatur`�-&,I gnfractor/iicense H`o der
STATE OF FLORIDA f
STATE OF FLORIDA
COUNTY OF R �L'r � _
COUNTY OF ` �TLt1(i1
The for oing instru` e t as acknowledged before me
The far oing instrument was acknowledged before me
this day of 20 by
this day of ,L
---� 20 L by
Namie'of person making'statemAt.
Name of person making statement.
l
Personally Known OR Produced Identification
Personally Known OR
Produced Identification
Type of Identification
Produced
Type of Identification
Produced
.Y
(Sign atureofNotaryPubfic-S a ri QtaryPubiicState ofFlor
a(Si atur4ofNotary Publi
_° 6 Melissa L Butterfield
Commission No. - `}{:. ((`4a 7 r(SL4$ommissiortGG30206
v* Notary Pubkic State of Florida
Co ission No. r,i�(;(i Melgg�utterfield
GG 302065
°F n Expires 02/14/2023
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° Expires 0211412023
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 1