HomeMy WebLinkAboutBuilding Permit Application (2) UPPLEM NTAL ?N-SUMT, L N SAW 1 M fi.
DESIGNER/ENGINEER: xx Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Fort Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 3401 S. US Hwy 1 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-resi tial use
WARNING TO OWNER: allure to Record�atice,of Commencement may resultin your p ing twice for
improvements to r prop ty.A Notice cement must be rec nd pos d on the jobsite
before the firs spectio you inte to obtain financing, consult lende or an a orney before
commencin ork or I our otice of Commencement.
SignatuKFFLORIDA
ner/Lessee/Con r r as Agent for Owner Signature of Co tractor/License Holde
STATE STATE OF FLORI
COUNt.Lucie COUNTY OF St Lucie
The forgoing instr4m nt was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of J UN 2020 by this 31 day of My 2020 by
Larry C Neese Larry C Neese
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
1w_-, ( � . W 00 14 n - wood
(Signature of NoVry Public-State of Florida) (Signature ofa�ry Public-State of Florida
Commission No. cif E A ��Y Punic State �gjryp�iss' n No. j"-16 S�of F�is
Amy N Wood Amy od
�^e C / 241645
My Comrtu"ion 241645 Expires 07125 2022AlExpires 07/25/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED L_
Rev.8/2/17