HomeMy WebLinkAboutBuilding Permit Pg 2 UpdatedDESIGNER/ENGINEER: Xx Not App
Name:_
Address:
City: _
Zip:
Phone
State:
MORTGAGE COMPANY:
Name:
Address:
CitV: Fort Pierce
Zip: Phone:.
— Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 3401 S. US Hwy 1 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-resi tial use
WARNING TO OWNER: allure to Record a tice of Commencement may result in your p ing twice for
improvements to r i�Z,
ty. A Notice omrnencement must be rec nd pos d on the jobsite
before the firs spectiou inte tc obtain financing, consult lende or an a orney before
commencin ork or our otice of Commencement.
Signature of wner/ Lessee/Con r r as Agent for Owner
Signature of Co tractor/License Holde
STATE F FLORIDA
STATE OF FLORI
COLIN Y OF St. Lucie
COUNTY OF St Lucie
The forgoing instrument was acknowledged before me
this day of , 20_ by
The forgoing instrument was acknowledged before me
this day of 20_ by
Larry C Neese
Larry C Neese
Name of person making statement
Personally Known OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of NoVy Public- State of Florida)
(Signature of ary Public- State of Florida
COmmISSIOn NO. Notary Public Stator
Amy N Wood
My Comm/ssion GG
Expir" 07125t2022
fLPjSS* n NO. `✓�i✓ iN " Scete Of Ronda
Amy °d
241645 My Commaision Gti 24t 645
Expires 07/25/2022
REVIEWS
FRONT
ZONING
00
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17