HomeMy WebLinkAboutAbigayle Doherty - Permit Application Complete
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:Rm;hxd Wilis Name: NIA
Address:5777 s Baru—street,sots Goa Address:
City: CO— State: co City: State:
Zip: 80210 Phone 303-474-5524 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING CpMpANY: Not Applicable
Name: NIA Name: NI'°'
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€nstallatian 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 I conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consuit 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 5t.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 inspect! . If you intend to obtain financing, consult
with lender or an attorneybefore commencingwork or rec din our Notice of Commencement.
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Signature of 0 ne ss ont etor as t for Owner Sign at1i re a Vontractor/ a Haider
STATE OF FLORIDA STATE OF COLORADO
COUNTY OF COUNTY OF Deft j
6 Sworn to(or affirmed)and subscribed before me of i Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization x cat Presence or Online Notarization
this day of ZC20 by this IMay of ft*-A 7020 by
To,sew
Name of person making statement. Name of person making statement.
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Personally Known OR Produced Identification Personally Known x OR Produced Identification r a
Type of Identificatio_ Type of Identification CO
Produced Produced wA N
(Sigrtfturiof Notary Public-State of Florida) /Ommligssion
nature of Notary Public State of Colorado} o m
Q a
Commission No. t Lydia �A} No. (Seal) z±n
N(JTA Y PL]BLIC o
—STATE OF FLORIDA 4
- Comm#GG9 78800
REVIEWS FRO r t9 ZE�kq 411 kRVISOR PLANS VEGETATION SEA TU RTLE MA
COUNTER RE EW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED j
Rev.516/20
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