HomeMy WebLinkAboutBuilding permit app page 2, updated, new contractor 11.9.20 I ,
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 y property. A Notice of Commencement must be recorded in the public records of St.
Lucie Count ost on the jobsite before the first inspection. If you intend to obtain financing, consult
with le r or a a fore commencing work or recording.your Notice of Commencement.
'g ature o ner/ ee/Contractor as Agent for Owner Sign to Co tract r/License Holder
TATE OF FLOR DA STATE OF FLORIDA r,
COUNTY OF LUC --� COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_P ysical Presence or Online Notarization 2hysical Presence o� nline Notarization
this � day of 2020 by this Q' day of 2020 by .
Name of ers n making statement. Name of person making ate ent.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentificatio Type of Identification
Produced _ Produced
(Signature of Notary u I State of Florida) (Signature of Notar
,.``aJP;;. ELLEN VAUGHN
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Commis State of FI i �iNotary Public
AUGH1 Commission No. - ommiss onn GG 270079
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REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
Rev.