HomeMy WebLinkAboutcramer permit app. page 2 suppupwm
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 EIONDING 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 toncurrency review:room additions,
accessory structures,swimming pools,fences,wads,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.
Signature of Owner/Lessee/Contractor as Agent for fawner Signature of Contractor/License Holder
STATE OF FLORIDA SV. STATE OF FLORIDA `
COUNTY OF COUNTY OF St. e.'
Swo to(or affirmed)and subscribed before me of Swo/'ho—�
or affirmed)and subscribed before me of
physical Presence ar Online Notarization Physical Prese c or Online Notarization
'i -J�day of rTb A ,202# by dli5 day of �d 202P by
l�tlt fir. 80411 �LccLl�t,�fvv���
Name of person makiAg statement. Name of person makinglstatement.
Personally Known ,-' _OR Produced Identification Personally known OR Produced Identification
Type of identification Type of Identification
Produced Produced
///21vt i6t W- 9. a - 47V-4JL49-
riggature of Notary=ic-State of Florida} (Signat Notary P ic-State of Florida}
CHRISTINE JOYCE CONWE(Se '�� CNRISrtNE.JpycE CONMrE!L eal}
Commissi YA Commi
to of Florida " State of Florida
Commlfslotl#GG 98470f , commission#GG 98470}or n,,.
Bonded thrau8h National Notary Assn. Bonded through Nat 24
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REVIE SUPERVISOR PLAN MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW— REVIEW
DATE
RECEIVED
DATE
COMPLETED
ILeV. 76720