HomeMy WebLinkAboutBuilding Permit Application (2)Signature Page - -
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x NotAppricable
Name: Nairn:
Address: Address• i
City: Sate: City: ! State:
Zip: Phone Zip: Phone: I
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FEE SIMPLETR'LE HOLDER: x Not Applicable I&ONDING COMPANY: � X Nor Applicable
Name: Narne:
Address: Address
City: City: I
Zip: Phone: Zip: Phone:_ I_
OWNERI CONTRACTOR AFFIOViT.Application is hereby madeto obtain a permit to do the wo k and installation as indicated.
1 certify that no work or installation has cotrstnenoed prior to the issuance of a permit. t,
St Lucre County intakes no representation that is granting apermitwill authorize the permit holder too build the subject structure
Which is in conti"tetwith any applicable Home Owners Association rules,bylaws or and covenants t*Imay restrietor prohibltsuch
structure_Please consult wrath your Home Owners Ammon and review your deed for sny restrictiofis which may applK "
In consideration of the g ant this requested perrnk I do hereby agnee.that I will,in all respects; the work
in accordance With the approved plans,the Fiarlda.Building Codes and St Jude County pmendmen
The following building permit applications are exempt from undergoing a full concurrenty mvlew:roc addhions,
accessorystructures,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 Cotrtrrrencernen!Wray result in Jl aymg twict?for
improvements to your property_AN of Commencement must be recorded in the public records of St
Wde County and posted on the iobsIM before the first irispection..if you i=41C
obtain financing,consult
with lender attorne before commencin uvorl<or recordin u uommencement
gnature of Owner/ / ctoras Agentfor Owner- Signature.of nse H older
STAVE O�I I Rt t 14 I STATE OF FLORIDA `
COUNTY OF Lr� S COUNTY OF I
Sworn to for affirmed)and subscribed before me of Sworn to(or affirm dl and subscrtbed.before me of
�P cal Presence or Online Notarbadon i."Physical Pce5ence #nliae Notarization I
this l�day of SG t' 2020 try�(t c r�OtR S. 1+o is u day of I 2= by
Wo CpYzen f. Foll/JO�tf pt}`� !c- t
Name of person making statement COR . =on making staterne�PersonallyKwmflRProd catNtl� EINI
ryt+ubkoven Olt P I n
Type of Identification �, id�tification s.: =-;E MYCOI<gi1SS10NlIH tG a
Produced Connm.E N fr D�►RESePtember
Ccy
(Signature of Notary Pubfic--State off)CK I t (S tutum cf Notary Pu tic-State of Ronda)
Commission No. Iseal) Commission No.. l W23 {sea[)
l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SE TURTLE MANGROVE
COUNTER REVIEW PEVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
Cf3MPLF{ED
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