HomeMy WebLinkAboutJames Korallis Permit App P2SUPPLE ONS"ROCT"ION.kI N LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
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 INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF. COMMENCEMENT."
7_5�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA•, ,
COUNTY OF (1Ci
COUNTY OF nT
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The forgoing instrument was acknowledged before me
The f r oing instrum nt was acknowledged before me
this�� day of (�QI� 20& by
this day of ( 200t_ by
✓i n n lTan ilcki ce5
126 V,12 0 Z►7a,,p
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification_
Type of Iden if' ion
liz tib S — 0
Type of Identification
Produced
Produced
Ek 124-
77-06 —D
(Signature
(Signature of Notary Public- State of Flo da )
EMAA CHRISTINE LYN �H'I1
Commissio N State of ar�tla
Commis EMMA CHRISTINE LYNCH (S al)
Commission N GG 961663
1UPERVISOR
• _ o ary Public ate of Florida
i�
Commission p GG 962663
my Comm. ExpireFeb 26 2f)2,
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REVIEWS
FRONT
ZONING
PLANS
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19