HomeMy WebLinkAboutBuilding Permit Application III APPLICABL I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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2300 VirginiaPierce FL 34982
Phone : ( 772 ) 462 - 1S53 Fax .* ( 772 ) 462 - 1578
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PERMIT APPLICATION FOR ,
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NSTRUCTION INFORMATION '* —. r+
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION �
DESIGNER/ ENGINEER : _ Not Applicable MORTGAGE COMPANY : _ Not Applicable
Name : Name :
Ad d ress : Address :
City : State : City : State :
Zip : Phone - - Zi p : Phone :
FEE SIMPLE TITLE HOLDER : _ Not Applicable BONDING COMPANY : _Not Applicable
Name : Name :
Address : Address :
City : City :
Zip : Phone : Zip : Phone :
OWNER/ CONTRACTOR AFFIDVIT ,p Application is hereby made to obtain a permit to do the work and installation as indicated .
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 con lict 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 .
0
Lucie County and posted on the Jobsite before the first inspection . If you intend to obtain financing , consult
with lender or an attorney before commenci' ng work or recordi' ng our Notice of Commencement .,
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Sig re of Owner/ Lessee/Contractor as Agent for Owner Signat of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST, � C / iz COUNTY OF S)
Swor to ( or affirmed ) and subscribed before me of Swore to or affirmed ) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this dayof .APP%, 1L , 2024 by this day of A Pf�I� , 2024 by
Name of person making statement . Name of person making statement .
Personally Known OR Produced Identification Personally Known v OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( SignatL& of Notary Public- State oT Florida u of Notary Public- State of F
�** Notary Public State of F orida � �tv Notary Pubfic :stateo loride
Commission No. c� a� y9gc� �' tral G ;� Margaret E Mont re
)Margaret E Montepa eCom SsiOn N0. E3o� 1 � M Cmmission G 990
My Commission GG 21 990 e Y
Expires 06/05/2022 Expires 06/05/202
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COU NTE R REVIEW REVI EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev . 5/ b/ Z