HomeMy WebLinkAboutBuilding Permit Application (2) 19141
sU, ''I =A a01 TRUC 1 ye` L IN "+ R TIO`N.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 noI1 yrepresentation that is granting a permit will authorize the permit holder to build the subject structure
structure.PleaseCconsult Wlthpyolur Home Owners Association andrreview your deed or any restrictions which maor
applyhibit such
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 commencinR work or recording our Notice of Commencement.
Signature of Ow er/Les /Contractor as Agent for Owner Sig to of Contractor/LiceHolder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF COUNTY OF . n(
Swgrh to(or affirmed)and subscribed before me of Sward to(or affirmed)and subscribed before me of
✓✓ Ph sical Presence or_Online Notarization ✓ ysical Pres n e o Online Notarization
this day of f .;020 by this day of 1020 by
/9
�,Ayin lPP veN � Allirl I Up
Name of of person making statement. Name of person making statement. ✓
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif Type of identific ' n
Produced Produced
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-01) State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS REVIEW SUPERVISOR
PLANS VEGETATION SEA LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.