HomeMy WebLinkAboutpermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t �1 _ Permit Number:
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Ridirlina Rprmit Anniirntinn
SUPPLEMENTAL ` ONSTRUCTION LIEN LAW WFORMATiON: - '--
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Tame:
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 Horne 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 your Notice of Commencement.
Wa4Vc1'4Sk_'0r
Signature of wner/ Lessee/Co 4-tor as A& or Owner
STATE OF FLORIDA
COUNTY OF
The f oing instr melt was acknowledgeed1before me
this day of�`l� 20 2 1 by
Name of person making statement
Personally Known OR Prod uce�l.dentification
Type of Identification
Produced
(SignaturVof Nibtary Public- State nffWorid;; 1
Commission
- wnr i.. wn�y ILA
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of ntractor/LicensAlder
STATE OF FLORI �
COUNTY OF ' to `�.1
The fo going instium r was acknowled d efore me
thi� day of �„ 20by
Name of person making statement J
Personally Known �OR Produced I0t1fiification
Type of Identification
Produced
ICi
ry Public- State of Florida )
PLANS VEGETATION
REVIEW REVIEW
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