HomeMy WebLinkAboutBuilding Permit Application (2) DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: iNot Applicable
Name: 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.
Il,-e4a e*e_�
Signature of Owner/Less a/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO I STATE OF FLORIDA
COUNTY OF�� U.)C'it COUNTY OF
Sw/OP
o(or affir ed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
sical Pre n or Online Notarization _Physical Presence or Online Notarization
thi day of (1 2024 by this_day of 2020 by
Lau—,
,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi rtl�i Type of Identification
Produced Produced
(Signature of I'--state of Florida) (Signature of Notary Public-State of Florida)
KAREN S. (Seal)
o` ;': ( ) SEN Commission No.Commission ps State e4 Florida-Notary Public
- R' Commission # GG 207484
9f P
""" June 12, 202 es
REVIEWS ISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20