HomeMy WebLinkAboutPage0002DESIGNER/ENGINEER: Not Applicable I MORTGAGE COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Name:
Address:
City:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Name:_
Address:
City:
zip:.
Phone:
State:
Not Applicable
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 obt ' financing, consult
with lender�or an attorney before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/C ntractor as Agent for Owner
Signature of Contractor/Li nse Holder
STATE OF FLORIDA t.
STATE OF FLORIDA
COUNTY OF S' 1-k C/ c�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
W Physical Presence or Online Notarization
�/ Physical Presence or Online Notarization
this A day of J—b C t42020 by
this LZday of �� �� , 2020 by
P)U_'0__d P #�,P ^.0 v sd\l
( HI21_ ST O OJV S d l
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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 Identification
Produced
Produced
(Signature of Notary Public- State�of Florida)
(SignatureIf Wry�rlaj_
Commission No. ;o�Y.pi%G, MART�(R
MARTHA A KERR
=_° •`�• G� Notary Public - State of F
Commissio : (�I
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�o Commission a GG 311213
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REVIEWS
ISOR
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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COMPLETED
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