HomeMy WebLinkAboutBuilding permit application, signed 4-26-21 , pg 2DESIGNER/ENGINEER: x Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: x— Not Applicable
Name:
Address:
City:
Zip: Phone:
WE
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
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 rec rds of St.
Lucie County and posted on the jobsite before the first inspection_ If you intend to obtain finan ' g, consult
with lender or an attorneybefore commence work or recordingour Notice of Commence nt.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA/�
COUNTY OF'05 C_/d
COUNTY OF
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 Not rization
this 30 day of (/�vi 202d by
this Zt' day of �Je.il 20 by
Name of person making statement.
Name of person making statement.
Personally Known-?" Produced Identification
Personally Known 3R�— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
SANDRA L. POLANIS
(Signature of Notary Public- t
"?
ignattsre of Notary Public Ion fission # GG 2t2026
SANDRA �. PS'�A
cf t� ,+'r' My Comm. Ex piresApr 24, 2022
Commission No.�„•,••, a Puntic atelo' Fa
Commission No. GG 2 ?—CdEd th ��l Nanat Notary Assn.
µy Gornm. Expires Apr F
Bon e
REVIEWS
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/ 20