HomeMy WebLinkAboutAPPLICATION Deutsch v�1 yng `4
DESIGN ER/ENG IN EER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: C i ty: State:
Zi p: P h o ne 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 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 attorneybefore commencingwork or recordion our Notice of Commencement.
MOM
Signat re of Ow er/Lessee/Contractor as Agent for Owner Sig ature of ntractor/License Holder
STATE OF FLORIDA . 1 STATE OF FLORIDA�n ��
COUNTY OF � N' i COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pretence or Online Notarization Physical Presence or On line Notarization
this day of by this_21Aday of�.11J� ,2B'by �
2-6 2.1
Name of person making statement. Name of person making statement.
Personally Known � OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Ah
P rod uced
n
mum
(Sigiiature of N tary ubli State i re of N ary PubtA-St
Notary Public State of Florida •,r���^, � � y �Nota�y Public State of Florida q
Comrnission No. t�+� SCalbanna Jayne Hall Com Sion No. : `r; ( 1a Jayne Hall �
v:. ,p� MY Commission GG 207585 M. � My Commissm GG 20158 0
�xWres 04115/2022 A;t.� �o'P Expires 04l15/2022 �
RE IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
REC IVED
DATE
COMPLETED
eV. /6/20