HomeMy WebLinkAboutBuilding Permit Application (2) IDESIGNER/ENGINEER _Not Applicable MORTGAGE COMPANY: _Not Applire
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 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 OYYNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT iN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
YVITH'YOUR LEADER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMOYCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF V COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,2411 by this_day of , 20_ by
C
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification I✓ Personally Known -OR Produced Identification
Type of Identification— y� Type of Identification
Produced I� Produced
1
(Signature of Notary Public 5 NIEL Et§ign ture of Notary Public-State of Florida )
KAREN S.
,rpY CUp�i a of Florida-Notar Public
Commission No. i° dj .(Seal)
*�S��My Commission Ex irC��s� ssion No.
12,
OF f�O��\ June 2o22
REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
l