HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: z_Not Applicable . MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State:_ City: State:_
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 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 pennkwill authorize the ermit holder to build the subject structure
which is In con ict with any applicable Home Owners Association rules,bylaws or an 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 attorney before commencing work or recording our Notice ofiCommencement.
Signature ofO ner/Lessee/Contractor as Agent for Owner SI n ture of tractor U rise Holde
STATEOFFLORIDA STATE O7LORIDA/
COUNTYOF 67, 4. 1'iR COUNTY - J7 Lrnclt
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
._Z' Physical Presence.or - Online Notarization _' Physical Presence or Online Notarization
this_I dayof sCPTC. fi.2 2020 by this Ab dayof AAA MrTT 2o2o by
Noel /Oezez 6A2 � Wl Al_1Ntz
Name of person making statement. Nameofperson making statement.
Personally Known_ ORPraducedidentification Personally Known, OR Produced Identification_
Type of Identification Type of Identification
Produced Pr uc,m;:7w�•,, OSMEL VALDES U „�
(Signature of Notary _ I _ o one .(Signature of Notary P t 6f Vaillblic-State of Florida
.y on a GG 368648' - omml eion MOG 368648
My Commission Expires M Cpm salon E% I
Commission No.( (60y1h 8, 2023 Commission No. k 3 C y l7g( on Exp roll
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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