HomeMy WebLinkAboutBuilding Permit ApplicationELECTRIC - COMMERCIALELECTRIC - COMMERCIALBuilding Permit Application 7/2312020 4:18 PM FROM: Staples TO: +17724621578 P. 2
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DESIGNER/ENGINEER: /Not Applicable MORTGAGE COMPANY: ; Not Applicable
Name: 7 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 thepermit 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
ith lender or an attorney before commencing work or recording our Notice of Commencerrwnt,
Signature of Owner/Lessee/Contractor as ASgJ r ner Signature of Contractor/License Hold —
STATE OF STATE OF FLORIDA
COUNTY OF FLORIDAW i ftp d. COUNTY OF �,i o }� o2
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
�Phy§§ical Presen a or Online Notarization ,_why 'cal Presenc o Online Notarizatloft
th' , Mklay of �,2d2t1 th' 4ay of 2020 by �-
J �t �
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identificationy' Personally Known OR Produced Identification
Type of Ide tificatio Type of Identificiti n
Produced ` `QQ,l,io(�„ Produce2/2
(Signature of Notary >i (Signature of
, t, -r ,iEAN RU6ENS DA,NTILIJJEAN RL)" D:NT LU$
Commission Na. q= ty t� }+w F,r,fi Commission N haY COt�ni:s5ioN# p587
ES:Oc+ober 11,2d 1
Bonded Thru Notary Public UndereMon
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20
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