HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGI PEER: Not Applicable MORTGAGE C PANY: _ 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:
Zi p: 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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Bolder
STATE OF FLORID STATE OF FLORIDA) �,,{'
COUNTY OF alid COUNTY OF ��n
Sworn to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
Physical Presence ox Online Notarization �Phycal Pres Online No arization
thisa2 day of ,2Q2 f by this� day of 202 by
Name of person making statement. / Name of person making statement.
Personally Known_ool OR Produced Identification ✓ Personally Known,_ FOR Produced Identification 4�-
Type of Ident' ication „ Type of Ide icatioEa
Pro( Produced
3,&;2 0 +
(Signs of N t a upal uIr Flonaa y (Signa re of N a P. tate o on a
�'c►� DAISYMC INNIS
�:_ DAISY M[GrNNIS
Notary Aubii S of Florid
�= Notary Pcblic Florida
Commission No. K § tie Commission No.
Commissidt R� 275597 mmission AMS97
My Comm.Expires Nov 92,POZx ° F` My Comm.Expires Novi 2,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED --__-_.
DATE
COMPLETED
Rev. /2V