HomeMy WebLinkAboutBuilding Permit Application a,os-
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DES ENGINEER:iGNER NotAPP plicable
MORTGAGE'COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City:. State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: TNot 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.
Inconsideration of the granting of this requested permlt;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 attorney befo1&aefmyfMng work or recording our Notice of Commencement.
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Signature of Owner/ es e'e&p1lactor a r 0 er Signature o n Contr c /Li Holder
STATE OF FLORIDA z STATE OF FLORIDA
COUNTY OF x- COUNTY OF
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Sworn to(or affirmed)and subscribed bef r Sworn to(or affirmed)and subscribed before me 3 3 N
x Physical Presence or Online N t z i n Physical Presence or Online Notarizat n3 9'�
this f D day of u 202 O this day of 'Sum ,2020 by ` 6
P a
ZN 'n
Name of person making statement. -n Name of person making statement. Q
Personally Known --,V,_OR Produced Id t isn Personally Known_Zi, _OR Produced Identifica -n°
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Pub ic-State of F a} (Signs re of Notary P lic-State of FI a}
Commission No. �7 �/ J ,) (Seal} Commission No.� 02�C�a (Seal)
REVIEWS FRONT ZONING i SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
516120
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