HomeMy WebLinkAboutINGARRA PERMIT PAGE 2DESIIGNER/ENGINEER.-
Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Naame:
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.-P Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 buil&the subj*e'ct structure
which is in conflict with any applicable Home Owne6 Association rulesl bylaws orand 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 I from undergoing a full concurrency review: room additions, J
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 IrO 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 YO .ENDER OR AN ATTORNEY FORE RECORDING YOUR NONCE OF COMMENCEMENT:"
J
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of to-
ntractof/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument wa- acknowledged before me
this day of A- 20,2Uby
.1
V,
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
The forg�qoipg -instrument was acknowledged before me
this d' -A
ay of.jr7 r 20 by
Name.of person making statement.
Personally Known OR Produced Identification
Type of Identification
P-rodu-ced--a
Aft.
HASSNA SASABIRA
Notary Public - State 01 P;Orida
4M54A sA,,A8Rt,,,t
K Commissior z GO 340327 �" ,
It, .28-2
commissior �G 3403 .7
%c-� taf� o"
(Signature o' Notary Public- tate' OtflOfi4ao�jh Natiora, Notary Assr. My COM, `AWE `IS (Signature of hi Lary -Public- State a e(! tpvough sjtlova. Nota tv A
•/7-
Commission No.
(Seal)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
REVIEW
DATE
-RECEIVED
DATE
COMPLETED
ev. 2/7/19