HomeMy WebLinkAboutPage0002k� CONSTI UG 1: N HEN,LAW I EORMATIO V. Y
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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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender ofan attorney beforecommencing work or recording o Notice of ComnxTcement.
Signature of Owner/ Lesse on actor as Agent for Owner Signature of Contractor/Lice a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF .Si-- LIA c/r
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization X Physical Presence or Online Notarization
this _L day of 2020 by this _.t,2 day of hJ �r , 2020 by
�#iZ oS 773 )W6 Jo/r , _W/ a rt �Iy s��s
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known k OR Produced Identification
Type of Identification Type of Identification
Produced Produced
L/.: I L a, 2L L — �)� a �_�1,44
(Signature of Notary Public- State of lorida) (Signature of Notary Public- State o Florida )
•''�������• MARTHAA KERB '
Col. 'Nod lorida (Seal) Commis. �e' , MARTHAA KERR (Se 1)
r o ary Public = State of Florida
Commission N GG 311213 ,` 'e:` Commission rl GG 311213
V:
Bonded zon
through National N tary Assn. xpires ar ,
R SUPERVISOR PLANS Bonde t r gh a I MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.