HomeMy WebLinkAboutBUILDING PERMIT APPLICATION � .
' Cost of Construction:$ Utilities: Sewer Septic Building Height:
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:K,,,*Ho- Name: i
Address:iwowr+iway Address:
City: wwpelms-h State: FL City: State:
Zip: 3U11 Phone sal-sac-mis Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
I Name:Frank min Name:
Address:Po sox„aa Address:
City
How S—W City:
i
Zi `p: 3U75 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,►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 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 ypur Notice of Commencement.
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Sigifature of Owner Lessee/Contractor as Agent for Owner Signa �e of ontractor/License Holder
STATE OF FLO A STATE OF FLORI
COUNTY Of tic_" COUNTY OF }r%& _
Sworn to(or affirmed)and subscri d before me of Sworn to(or affirmed)and subscri d before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this Qk day of lA 2024 by this day of4 2021 by i
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!dame of person making statement. ! Name of person making statement.
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Personally Know OR Produced identification I Personally Know OR Produced Identification
Type of ldentif' ation r - TYpe`tif Ident'i ation
Produced Produced
(Signature of No y 4s Sta s _Tipra� (Signature of Notary Staten xI
rya.,ice va,4aZ a� t r,,,+at
Commission No Commission No. ' `)c 1z SC � Gy
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW 1 REVIEW
_..-..._._ I
DATE t _.._.. _._....__.��_ i-- ,
RECEIVED
DATE
COMPLETED
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