HomeMy WebLinkAboutBuilding Permit Application (2) u a s�ar r r s r ry
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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 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 f Owner/Lessee/Contractor as Agent for Owner Signa u of Contractor/License Holder
STATE OF ORIDA C_ STATE FLORIDA
COUNTY OF , 4 . L► tC t-C COUNTY OF Cte—
Sworn (or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this_a(pday of(D QJ-0 — 2020 by this�day of nC'A0 r 2020 by
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Name of person making sstt ment. Name of person making statement.
Y
Personal) Known V OR Produced Identification Personally Known v-11"OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatu of Notary Public-Sta at a of Notary Public-State o
Notary Public state of Flor a c� J10 Notary Public State of FI da
Commission No.�& a rgaret E Montepare CO ission No.(4-3Q-1y_`�0 :� IMargaret E Montep r
M Commission GG 2149 0
Expires 08/05/2022 MY Commission GG 2 4
V w �p w Expires 06/05/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20