HomeMy WebLinkAboutduersten permit appINEER: _ Not Applicable
Name:_
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
TION:
MORTGAGE COMPANY:
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Not Applicable
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BONDING COMPANY: Not Applicable
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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 n attoftey before cQjm*ncing work or recgrdirig your NotiWpf Commencement.
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Sign ure of Owner/ Lessee/Contractor as rybt~%r 0 er Signature of Contr ctor/License Holder
STATE OF FLO DA STATE OF FLORIDA
COUNTY OF�00f i COUNTY OF
Sworpto {or affirmed) and subscribed before m_r Sworn to (or affirmed) and subscribed before me of
Ph sical Pre�sgnce or Online Notariz 0 'b Physical Presence or Online Notarization
this 1,g day OfMdga 2020 by this L'8 day of _&dd4.jZ 2029f by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification �✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Pr�r + '.-Q, I Produced
Signature of Notary Public- State of Florida )
Commission No. 1 (Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
DATE
COMPLETED
(Signature of Notary Pu
Commission No.1
S REVIEWOR I REVIEW PLANS I VREV EWON 5EATURT
REVIEW
ALBERT K I
C06"SSION
REVIEW