HomeMy WebLinkAboutBuilding Permit Application , pg 2 Dec 15 20,02:53p p.1
0357 .
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DESIGNERANGINEER: 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 certi.N fhat 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 wok
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential.use
"WAR 1.N TO O NER: YOUR FAILURE TO RECORD A NOTICE OF
CM NCE§E�t MqyRES LT 1N YOUR PAY! G TWICE FOR
C� SZO
OR pRpPERT`Ifq OT CE pF COMENCE%WT M
RRSTED ON �'H Jf�B SITE BEEFORE F
rglytJ
ON. IF YOX INTEND TO OBTAIN FINANCING CQNSULT WITH YOUR
. O}� q� „ATTORNEY BEFORE RECORDING YOUR NOTICE OF
CNCEMENT.
Sig _ re a Owner/Lessee/Co actor as Agent for Owner Sign at o ontractorJLicense Holder
STATE OF FLORIDA STATE OF FLORIDA
-COUNTYOF 02 Vucze i� COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before ine
` this -day of IRIMil 20 by this��day of i = - =92 20,9.L;by
Name of person making statement. Name of person making statement,
Personally Known OR Produced Identifi 4 Personally Known OR Produced Identification_ �
Type of Identification ggoqq\19�il.�j� Type of Identification
Produced t �> >ti°�Ngq,(i~R GD.;yF2���'�i Produced q q`011191:!!,E ;11,
•� , •1,�sstcNErp ., �. °"�A��ER GOi,;rC!'��{,.
`ON'
(Signature of Notary P lic-St to of l Ida) G9265A5 `„ (Signature of Notary Public- to-of SIo ' = J
Commission No. G12 C�.1oS*5 { ap}p i ? Sk o
t�i---�-- �� o�J11,FL5�cUe`by`�c'`? Commission No. �Ca��1L15`�'� 'p� a�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE �0A;Ir V6V' E
COUNTER . REVIEW REVIEW REVIEW REVIEW REVIEW REVIEWI
DATE
RECEIVED
DATE
COMPLETED
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