HomeMy WebLinkAboutbuilding permit (2)SUPPLEMENT4 C(
DESIGNER/ENGINEER
NSTRUCTION LIEN LAVA INFORMATION
Name:
Address:
City:
Zip: Phone
— Not Applicable
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
NOt Applicable
Not Applicable
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 1 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 addition,
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 payin twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature o wner/ Lessee/Contractor as Agent for Owner Signature of Con License Holder
STATE OF FLORIDA
COUNTY OF STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged b More me
thisZj day of 20� by this Za day of 2019 ly
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(Name of person acknowledging) I,---
(Name of person acknowledging)
(Sign)ture of Notary Public- State of Florida)
(Sig ture of Notary public- State of Florida )
Personally Known
OR Produced Identification
Personally Known
Type of Identification
Type of Identification
OR Produced Iden
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Produced
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DATE
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DATE
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