HomeMy WebLinkAboutPIPER PERMIT PAGE 2ORM . .•. • ..... ,.
DESIGNIER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _____
Not Applicable
BONDING COMPANY: Not Applicable
Nam6:
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 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 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, ],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 additiohs,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may-msult in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencements,
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Cont ctor/License Holder tl
STATE OF FLORIDA�
COUNTY OF J UC f
STATE OF FLORIDA
-
COUNTY OF.
The forgoing instrument was acknowledged before me
The forgoing instru , ent was acknowledged before me
this Zi'l day of 't ! G rC,l z0�i by
this 20 Giday of 7_02-1 by
J
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(Name of person acknowledging)
(Name'of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary,Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification -
Type of identification
CliltlSTIfVAMARIESALTCS
Produced l
poi �s CHRISTINA MAIZE SALTOS
Produced �PYY PU
z. :o My COMMISSION #GG270307
"'A -My
Commission No. 1 � -My COMMISSION #GG270307
� � � � ���� � �3� EX RES: OCT 23, 2022
No. �orough
Goaded through 1st State Insurance
.Commission lstState lnsurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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