HomeMy WebLinkAboutBuilding Permit Application
DESIGNERIENGINEER: Not Applicable MORTGAGE COMPANY: Not Applica ble
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 Home Owners bylaws
any applicable Association rules, 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.
Lessee/Contractor as Agent for Owner
I
Signature of Contractor/License Holder
LORIDA
STATE OF FLORIDA
F_ S C 12
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COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph ical Presen r Online Notarization
Physical Presence or _ Online Notarization
this - day ofp C ��. ""2``020 by,�/�
n/1 (�
this i day of 2020 by
Name of person making st1ifem—tr6t.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi
tV
Type of identification
Produced_ )�
Produced
(Signature of Notary Publi - State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Commission No. (Seal)
ELLEN VAUGHN
REVIEWS
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Commission 4
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GG 270079
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PLANS
VEGETATION
SEA TURTLE
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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