HomeMy WebLinkAboutKillackey permit page 2. ,_. '_ .·_·.-'
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable_ Name:. _________________ _ Name: __________________ _
Address:. _______________ _
City: ___________ State: __
Address: _______________ _
City: ____________ State: __
Zip: _____ Phone. _________ _ Zip: _____ Phone:. __________ _
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Addres_s_: ---------------
Name:. __________________ _
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 permiL
St. Lucie Countv makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any appficable Home Owners Association rules, bylaws or and c:ovenants that may restrict or l)l'!lhibit 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 fuH concurrency review: room add"rtions,
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 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 attome before commencin work or recordin our Notice of Commencement.
Signature of OWner / Lessee/Contractor as Agent for Owner -
STATE OF FLORIDA S\-l U(V,
COUNTY OF •
Swo,4o (or affirmed) and subscribed before me of _V_i, Phh:ysical Presence or __ Online Notarization
tlli5·.Lt,_ day of 'ifi, I y , 202f by
tl~e~!m~~tement.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced.--------:;;--,.,----
Commission
REVIEWS
DATE
RECEIVED
DATE
COMPlffiD
FRONT
COUNlER
ZONING
REVIEW
SUPERVISOR
REVIEW
Signature of Contractor /license Holder
STATE OF FLORIDA c .L. r , ,,.;,,,
COUNTYOF _____ -;:i._,1_._L-li'UL--___ _
Sw~(or affirmed) and subscribed before me of
__ Physical Pres.,;n.ce or __ Online Notarization
-~ day of :J. /y . 207' by
Nti~.!mat:!'tl~ent.
Personally Known / OR Produced Identification __ _
Type of Identification
Produced.------,,----,,,,,_ __
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
GROVE
REVIEW