HomeMy WebLinkAboutBuilding Permit Application, page 2DESIGNER%ENGINEER; ^Nat Applicable MORTGAGE COMPANY: _ Not Appiicable
Name: _ 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.
5t. Lucie Counter makes no representation that is grants Ng 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 Assiriation and review your deed for any restrictions which may apply.
In consideration of the granting cf this requested perm'!, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Bu:lding Codes and 5t, Lucie County Amendments.
The following building permit appiication5 are exempt from undergoing a full concurrency review: room addition$,
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 attorrlgy_�sef+ere comme )cjng work or recordin flur Notice of Commencement.
Signature of Owner/ l_es5ee}Contractor as Agent for Owner
STATE OF FLORIDA � (_LA C d
COUNTY OF
SworVno for affirmed} nd subscribed before me of Physical Presence or Online Notarization
thw +L`"day of 2 t by
c�.i-td-ar� ll i 1 I vi_ . v
Name of person making statement.
Personally Known ` _ OR Produced Identification
ATp,e of ldentifi �nPu
(Signature of No arr(y1 ublic- state of FloridSt
Commission fe
y F .taw Selo
{' S 4 dui iL' 3vBGGG 3A2376
V tipNM Q {7G e..02a
REVIEWS FRONT ZONMG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED