HomeMy WebLinkAboutBuilding Permit Application (2)SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 our Notice of Commencement.
A/
Signa r f Ow Lessee ontractor as Agent for Owner
Con for/Lic
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STA E OF FLORIDA
STAFLORIDA
COUNTY OF STLUCIE
COUNTY OF STLUCIE
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and
subscribed before me of
Physical Presence or Online Notarization
Physical Presence or
Online Notarization
this / day of APRIL 2021 2020 by
this ! day of APRIL zo2,
2020 by
GARY W ZANELLO
GARY W ZANELLO
Name of person making statement.
Name of person making statement.
Personally Known xx OR Produced Identification
Personally Known xx
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu Florid
(Signature of Notary a i
01®'iGG3 858
Conlnl.GG3 658
Commission No. GGssassa i • �,w�
Commission No. GGsso
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5