HomeMy WebLinkAboutBuilding permit app pg 2SUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE CDMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State:_._ City: State: --Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ~ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ OONTRACIOR AfflDVIT: Applit a•n-• is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or ;nstaffatinn has commencal prior to the issuance of a permit.
St. Lucie County makes no ~ that is gr.mt!ng a~ will authorize the uennit holder to build the~ structure
• which is in conflict with any~ Home OWners Assiw Mi,-, rules. bylaws or and covenants that may restrict or Pfl)hibit such
structure. Please mnsult
0
t.-witll.....,your Home OWners Association and review your deed for-any restlictions which may apply.
In consideration of th,, g,aulil,gufthis requested permit, I do hereby agree that I will, in aD 'l!spects, perform the work
in acmrdance with the approved plans, the Florida Building Codes and St. Lucie County llmendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessorv structures, swimming pools, fences, walls, signs, saeen rooms and accessory •,ses to another IIOIHeSidential use
WARNING 10 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 jobslte
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work or remrdi Notice of Commencement.
Signa~r,u,ssee/Contractoi~~ Signature of Contractor/Ucense Holder
~t~ ~A':,f. 4/lie-STATE OF FWRIDA St l ' COUNTY OF . Ul(lJ
The~nginstrumentwas adcnowledged before me
t11is.llhavot UQ.(ct,, .20.1L. by
The fol!!oing instrument adcnowledged before me
this~dayof Mortt: .20:i1_ by
Name~~~l1~4
Per.ionally Known OR Produtedldenlilication __
Type ofldentifitawn
M,~~i!; Nameof . sta
Personallv Known OR Produced Identification __ _
Type of ldt:ntifrcation Produced. ________ _ Produced, _________ _
(Signature of Notary
~()_,~
{Signatun,of Notary Pubiffstate of Florida )
E CONWELL
ry P • at, of Florid< Com • I)
mmlsslon # GC. 914701
··•.............. My Comm. Exp1,., AIJI 21, 202 ◄
REVIEWS FRONT ZONING SUPERVISOR PlANS MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
COUNlER REVIEW REVIEW REVIEW REVIEW REVIEW