HomeMy WebLinkAboutGROVE COMMUNITY1DESIGNER/ENGINEER: Applicable
_Not MORTGAGE COMPANY: Applicable
_Not
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 or an attorney before commencing work or recording our Notice of Commencement.
Signatu o caner/ Lessee/Contractor as Agent for Owner
Signatu of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF L)CIf—,
STATE OF FLORIDA
COUNTY OF S.. l_(IGIP�
Swor o (or affirmed) and subscribed before me of
Physical Presence Online
Swor to (or affirmed) and subscribed before me of
or Notarization
this J c_5 day of AtuquS 2020 by
Physical Presence or Online Notarization
this _I�) day of Xqu uS 2020 by
Ma4ulok_
, MocW Q,
Name of person making statement.
Name of person making statement.
Personally Known V/ OR Produced Identification
XOR
Personally KnownProduced Identification
Type of Identification
Type of Identification
Produced
Produced
�CV4C�QlZet & ,
w (9. me nQ n
(Signat re of Notary Public- State of Florida)
(Signat re of Notary Public- State of Florida
Commission No. u►*' Not(% Olic State of Florida
Margaret E Montepare
Commission No. 01%. Nqt� �'c State of Florida
Mgt' E Montepare
Y My Commission GG 214990
My Commission GG 214990
Expires 06/05/2022
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