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DESIGNER/ENGINEER: x
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
x Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: x
Name:
Not Applicable
BONDING COMPANY:
Name:
x Not Applicable
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 commencine work or recording vour Notice of Commencement.
Id
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as Agent for Owner
STATE OF FLORIDA`--C of J , A
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this y of , 2020 by
Name of person n
Personally Known
Type of IdentifiCdl
Produce f
(Signatulre of Not
Commission No.`
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
State
FRONT I ZONING
COUNTER REVIEW
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Signature of Contractor/Licerise HoIdEl� /
STATE OF FLORIDA l/i�W�I�X.
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OFtocy(or affirmed) and subscribed before me of
si al Presence or Online Notarization
this y of, 2020 by
Name of person making;sfatement.
Personally Known OR Produced Identification -
Type Identificatioi
Produced 1
trdture of Notary Public Stat ,a,E of Flo/,da-Nola
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7 7 May 02, 202.
SUPERVISOR
I PLANS REVIEW I VEGETATION S REVIEW LE I MANGROVE REVIEW
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