HomeMy WebLinkAbout1597 Bowditch permit back sideI
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I IDESIGNER/ENG INFER: Not Applicable MORTGAGE COMPANY: Not Applicable
N a in e : suMiITDEslGN & FORENsics, iNc Name:
Ad d ress : 725 sE PORT ST LuciE BLVD Address:
city: pORTSTLuciE state: FL City: State:
zi p: 34984 phone 772.285.0572 Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name:Name:
Address:Address:
Cit.Cit.
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.
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ln consideration of the granting of this requested permit, I cid hereby agr.ee that I wiii, in aii respects, Perf6rrri 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
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ng, consultintend to obtain financi
work or recordin
Lucie County and posted on the jobsite before the first inspection
with lender or an attorne before commencin otice of Com ncement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY 0F
Sworn to (or affirmed) and subscribed before me of
Signature of
STATE OF FLORIDA
COUNTY 0F ecLCLL~
Sworn to (or affirmed) and subscribed before me of
I
_ Physical presence or online Notarization drELsj:a;I:fresj¥£rtTohli,nfo¥%ta#ati6nI•..this_dayof 2020 by
Name of person making statement.Nameofpersonmakingstate nt.
Personally Known OR produced Identification Personally Known OR produced Identification
Type of Identification Type of Identification
Produced pr.tEfro= _A
(Signature of Notary Public-State of Florida )CommissionNo.(Seal)(Signature of Notary Public-State-of F 8rida )
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION sRE%
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COUNTER REVIEW REVIEW REVIEW REVIEW EVIEW
DATERECEIVED Vii-
DATECOMPLETED
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