HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
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 AFFIDAVIT: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 kructure
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,iri 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•tsanothef non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE'OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS'TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF—YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR- OTI E OF COMMENCEMENT_"
Signature of Owner/Lessee/Contractor as'Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA C�
COUNTY OF :q LLB COUNTY OF -
The forgoing instrument was acknowledged before me The forgoing instru ent+wa acknowledged before me
this day of� '�C} �-- 2a by this day of -+'; �,,20-2-C)by
LL,CJ 0, ;(e art "'e., tG la '�-
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced IdentificatioA
Type of Identification Type of Identification
Produced W'yk-l'S- /--] Ca )LC4 T76,(, 4 Produced a, V t.4 t t CLa)t_S-/
Notarization valid tes Notarization validate
1 signature W4 , , mature only,
not document c0i lten , V'---not document 22nter
(Signature of Notary P. lic-State ofJFli i e of Notary Public-StateHASSsA SAS 3RiA HA55tiA SAhA3n"IA
Commission No. � Zq..: Notary Public-Sta e �61,3 7 tar Pub i[-Sia,e;.' nr
u3��t'Id�s on No. 4F r� My Cocrm'ssiorrreG' 17
83 2023 � y My CommCOmmission z GG 3 0 1 3
L !.fora.tipt::r A r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGRO E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19