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: Not 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 con urrency review:ro additions,
accessory structures, swimming pools,fences,walls, signs,screen rooms and acce�pry use to ano er non-resid tial use
WARNING TO OWNER:Your failure to Record a Notice of Commencemen""ma/cd
n payin i:jna/n
improvements to your property. A Notice of Commencement must b d in t pubords of St.
Lucie County and posted on the jobsite before the first ins ction. If yo to tain fig, consult
'th lender or an attorne before commencin work or reco in ourf ommenc .
t
tgna Niner/Lessee/Contr ctor as Agent for Owner Si ature of no r icelnse Id
STATE OF FLORIDA 5� �-�Jl-w, STA COU Y OF
ORt A
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sw n to r irmed) an s scribed befo me of
Ph sical Presence or Online tarization Physic Presence r Online Not ization
this day of_� 2021 by is f 2020 by
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Name of person making statemen . Nam of perso m king statement.
Personally Known OR Produced Identification P sonally6/own OR Produce Identification
Type of Identification pe o/1� ntification_N
Produced _ Produc
(Signature of Notary Public- of Florida ) (S' nature of Notary Public-Stat of Florida )
Commission No. �. y ommission No.
� *')VAU( P„bi;o (Seal)
Notary
._ �prr:rnissi�t # GG 270079
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REVIEWS FFIRI"tim, tO�® � ' xoz2 PLANS VEGETATION SEA TURTLE MANGR VE
COU VIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
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