HomeMy WebLinkAboutBuilding Permit Application SUPPLEMEiTALCONSTRUiON LIEN LAW INFORiUlATiON
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DESIGNERjENGINEER. 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.
certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Countv makes no representation that is granting apermit will authorize thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an 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 Cbdes 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 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.
Signature/6f Owner/Less /contractor as Agent for Owner Signature of C ntractor/Lice a Holder
STATE OF FLORIDA r STATE OF FLORID
COUNTY OF (1k t? I C COUNTY OF LU C l e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9 day of TU yke _,20 26 by this 9, day of 7�Av1e 20 W- by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally known _OR Produced Identification
Type of Identification Type of WeDffification
Prod Prod ed _
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O!!! Public State of Fhana ide btic State of F.10"da
{Signatu ota t�ti�tp�i °020879 {Signat P }
OF ' orr�d" S ptresOSNB12824
Expires 081 '�y,, 4 om
Commission No. scommissio Nc3 "� a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMP ETED
Rev.8/2/17