HomeMy WebLinkAboutBuilding Permit Application (2) UPI �ENTIl3�f FtUCT10N LIEN C1W 1NC7Ria7C)N
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 herebyagree 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,wails,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 po ted on the jobsite before the first inspecli4op.If you intend to Obtain financing,consult
,wMender or an al:Yorney before commencing work or-r2a initNyour Notice of mencement.
S gnature ofowner/ ractor•as Agent�for owner Signature` ntractorj6icen°e"ridid
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 13}'1I.)nr-.l COUNTY OF BrULAC.XG_
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 M CSt 4— 2020 by this_.J�7 day of M tr Y 202q by
�Ot)Gild O eeo
Name of person making statement Name of person making statement.
Personally Known�OR Produced Identification Personally Known > OR Produced Identification
Type.of identification Type of identification
Produced Produced
(Signature o Notary Public-S SI nature of Notary Public at ,
,���*` fi-N LAURIE PHILLI S>Sr• LAURIE PHILL ! sion No.Nfl@ JSt�2 z�l1Pebtic-state-of F o
Commission No. 2. tip y Public-State o r'D Sn7lnission a H.H 8T 8
-' •c Commission g HH @7802 ti,��it?a� �y Commiesioo.Ex i o
M Com pits n5
eprunt 01,2 25
REVIEWS FRONT VEGETATION SEA TURTLE M
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I
DATE
COMPLETED
rev.5/6/20