HomeMy WebLinkAboutBuilding Permit Application (2)/ Signature page �► I
E
••.Trib1`a.7.F^eii'•_
I DFS)IGNMENGINEER: x�NotApplicable MORTGAGE :PANY O x
C M , Not Applicable
! Name: Name:
lAddress- Address:
i Ctfy: State: City: I State:
Zip: Phone Zip: Phone; I
i FEE SIMPLETITI.E HOLDER: x Not Applicable BONDING COMPANY: j x Not Applicable
` Name: Name:
Address: Address: !
City. --
Zip: Phone: _ Zip: Phone- - ---1----- - -
OWNW CONTRACTOR AlFFIDVIT:Appri awn is hereby madeto obtain a permit to do the woFk and installation as Indicated.
1 certify that no work or inutallation has conmwnced prior to the issuance of a permit.
St Lucie County makes no representation that is granting aperinitwill authorize the permit holder to-!build the sub)ectsbvctare
which is in coriietwrtlr any applicable Nome Owners AssocraGon rules, or and covenants that'irnay nestrictor prohibit such
structure.please conw th ltu your Home Owners Association and review your deed forany resWctiops which may apply.
Inconsideration of the granting of this requested permit,I do hereby agree.that I will,in all respects;.' rTorm the work
in accordance with the approved plans,the Florida.Building Codes and St Lucie County Amendments
The following bWddfng permit applications are exempt from undergping a full concurrency review:ro(maddictions,
atxessoryst iWures,swimming pools,fences,watts,signs,sueen rooms and accessory uses to another non-resWemiat use
WARNING TO OWNER:Your failure to Record a Notice of Commencement May result In haying twice for
improvements to your property.A.Notfce of Commencement must be recorded.ln the public records of St
Lucie County and posted on the jobsite before the first inspection.lf you inters iO obtain financing,consult
with lender at uk t i Cammencernent
gnatur,e of Owner/ J ctoras Agent for Owner Signature.oE nseHWdar
STATE OF in Rt ! STATE OF FLORIDA
TY L
COUN OF er'S COUNTY OF arts c7`
Sworn to for affirmed)and subscribed before me of Sworn to(or afl`irrned)and subscrfbed.befwa me of
te-"P cal Presence or Online Notarization i/Physical Presence r '—Online Notarization
this, day of SGp� 2020 by 14fr�ol2s. this. ay o$ 1 2= by
r� Fir�3oil-ar P
tots rj�
Name of person making statement. CORM f siho on making statement:
1
No Public oven OR P j PersonatlyKnown flit Prod cation. IY
Type of Identification C ideyt'tfication MyCOAgMSSION
Produced Corral.E ices N ( ~6pactat
i
ftnatnre 4f Notary Pubrrc-State off) if, (S-igeatum of Nofa y pu Iio--St3td
I of Florida j
commission No. a1"70-72%4 ism) Commission No.H !6 3
REVIEWS FRONT" ZONING SUPERVISOR PLANS VEGETATION SE URTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
[SATE �
COMPLETED
Rev. i