HomeMy WebLinkAboutBuilding permit app, pg 2SL L•6MENTAIL•CsO':ti'STRUCTION'LIEN LAW INFORIVIATIOV.;
DESIGNER ENGINEER: X Not Applicable I MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name:
Address: I 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, 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attornev before commencing work or recofding your Notice of ComMencement.
of owner/ tegee%Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OFPa11Beach
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
this 1st day of Marh.202f 190
Vidd Kimball ,�ptt ►u FlotarY PubUc7Stt, of Florida
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Personall Produced Identification
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ZSignatUre of Notary Pbblic- State of Florida ) /
Commission No. (Seal) /
REVIEWS FRONT ZONING SUPERVISOR
COUNTER I REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA
COUNTY OFPalmBeaa,
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
this 1st da f March2021 2020 by
�W Notary Puc Sta
blite of Florida
MarkAVines `(.
Name of pe Zl�__109
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Personally Known
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Type of identification _
(Signature of Notary Public- State of
Commission No. (Seal)
PLANS
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