HomeMy WebLinkAboutBuilding Permit ApplcationDE5IGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE 51MPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: _ Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that noworkwork or installation has commenced prior to the issuance of a permit.
St.
is in conflicmtawith any apphcablelon Ho a that
Asssociation ru esabylaws or and permit
venantds that build
ay the
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND Q OBTAIN FINANCING, CONSULT
WITH YOUR LEN 2E"R AN ATT RNEY BEFORE RECORDING YOUR NOTIC MENCEM
f� 7//-777,, _
of Owner/ Lessee/Contractor as Agent for Owner natur of f Contractor/License Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ _-�� COUNTY OF S� L[( C VC W
The for oing instrument was acknowledged before me
this day of M6 _ 20 Z) by
Name of person making statement.
The fP r oing instrument was acknowledged 4efore me
this cn day of 20G2,by
Name of person making statement.
Personally Known
Type of Identification
OR Produced Identification
Personally Known
OR Produced identification
Produced nL_
Type of identification
Produced_
j
(Signature of Notary Pub
-
(Signature of Notary Pu
State of Florida)
Commission No.
$Cot° Of da GHN
Commission No.
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REVIEWS FR tob r SCR PLANS VEGETATION FSE7ATt1RTLE �
COUNTER REVIE REVIEW REVIEW REVIEW REVIEW n rr I.1--- �r/
DATE
COMPLETED