HomeMy WebLinkAbout126 n las olas permit appl_notary seal & signature_ jan 7 2021DESIGNER/,GINEER: _ Not Applicable
Name: · \lt ~}1 -I Z;:11{
Addre~: 'S lUr :sf · City: otc sr we., State: _£L_
Zip: '3998':\ Phone 172 -12£-'l QqR
MORTGAGE COMPANY:
Natne: Addres._s_: --------------
City: ____________ State:
Zip: ____ Phone:. _________ _
..X,. Not Applicable
FEE SIMPLE TITLE HOLDER: Name:. _______________ _
Address:. _______________ _
City:·----~---------Zip: ____ ;....· Phone: ________ _
Not Applicable BONDING COMPANY: Name:. ________________ _
Address: ....... ______________ _
City:. _______________ _
Zip: _____ Phone:. __________ _
..X.Not Applicable
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 ~rmlt will authorize thegermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an covenants that mav. 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,
aq:essory 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 p perty. A Notice o. Commencement must be recorded in the public records of St. Lucie County and poste n the jobsite bef<?, e the first inspection. If you intend to obtain financing, consult
with lender or an attorn before commen · m work or recordin our Notice of Commencement.
s· nature of Owner/ Les e/Contractor as Age
STATEeF+EORibA
COUNTY OF -'-
S~o.91 to (or affirmed} and subscribed before me of
--1.~~cal Presenc~ or . · Online Notarization
thisJd_ ayof ,2020 by
f1o frAm+tti> [?dv "1 no~
Name of person making-statement ..
Personally Known __ ,,t;. oduced Identification K
Type of ldentifica ion
Produced,_.......1..;.E:Lll!li~...,,a.~~~::..
Signature of Contractor/License Holder
STATE OF FLORIDA COUNTY OF __________ _
Sworn to (or affirmed) and subscribed before me of
· __ Physical Presence or __ Online Notarization
this __ day of ______ _, 2020 by
Name of person making statement.
Personally Known ___ OR Produced Identification __ _
Type of Identification
Produced. _________ _
:. ._\•~~ ~~'-=-I -: .. :::
FRONT ZONI~ , $UPERVISOR :·PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEWS
COUNTER REVIEW':: -·~f!E .. V~EW ' " -!!£VIEW REVIEW REVIEW
DATE
. RECEIVED
DATE
COM D