HomeMy WebLinkAboutPermit App (2)DESIGNER/ENGINEER: X Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _y Not Applicable
Name: `
Address:
City:
Zip: Phone:
MORTGAGE CO
Name:
Address:
City:
Zip:
BONDING CO
Name:
Address:
City:
Zip:
one:.
IY:
)ne:
'�L Not Applicable
tate:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permi I o 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 perr I iit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cok enants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for a iy restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in], 'll respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie CountyA Inendments.
The following building permit applications are exempt from undergoing a full concurren review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory L les 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 COMMI NCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INT NDTO OBTAIN FINANCING, CONSULT
WITH YnUR LENDER nR AN ATTORNEY RFFDRF RFrnpnmr. YniIR NnTICI nF rnmmFNrFMFNT"
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contra
r/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF ST LUCIE
COUNTY OF ST LUCI
.,nt was acknowledged before me
The forgoing instrument was acknowledged before me
The forgoing instru I
this 23 day of APRIL 2� by
this 23 day of APRT,
20Q;:.) by
Name of person making statement.
Name of person mak
g statement.
Personally Known x OR Produced Identification
Personally Known x
i OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced �I
(Signature of Notary P blit- State of Flo ida)
(Signature of Notary
ubll - State of Florida )0
PU,, TIFFANY METZGE
X00
Commission No. al) Commission#GG 35
1H mmission No.
,rn���o FANYMETZGER
n �� (Seng
* *
Expires April 26, 20
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* Commission # GG 356108
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, .•E pires April 26, 2022
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