HomeMy WebLinkAboutBuilding Permit App, Pg. 2 ;2-103-_- -_Off'7 ?
' SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ER_ / Not Applicable
7m6_RT AGE COMPANY: Not Applicable
_ _E__NG I N E E R.
Name: PA A IIJ L 6 L R Name:
Address: 22gq glrkAug sr= Address:
City: UERO 92t-Z)Qv_ b State: r-L City: —State:
Zip: 3,29 fel Phone— �,I,;L -?;-i Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Ix 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 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 attorney before commencing work or recording your Notice of Commencement.
A 17
Signature of Own' /Lessee/Contractor as Agent for Owner Signature OfLContractor/License Holder
STATE OF FLORIDA — STATE OF FLORIDAP
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Name of person making statement. Name of person making statement.
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Type of Identification i Type of Identification
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GUADALUPE MARZOA
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CDmmissior *oACJJ:11 Commissi 11 1Notary Public,State of FIO('5 a
My comm.expires NOV.29,2023 --tVMM`1M1-n#GG 926670
My comm.expires NOV.29,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER i REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
15ATE
RECEIVED
DATE
Re COMPLETED