HomeMy WebLinkAboutBuilding permit app pg 2DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
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 AFADVIT: 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 Countv makes no repre_sentation that is granting a permit will authorize the permit hokier to build the subject structure
which is in conflict with any ;ipplicable Home OWners Association rules, bylaws or and covenants that ma,; 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 attome before commend work or recordin our Notice of Commencement.
Signature of OWner / Lessee/Contractor as Agent for Owner -Signature of Contractor/License Holder
STATEOFFLORtDA 5\-l...udL
COUNTY OF •
STATE OF FLORIDA c .L. r , ,11l.o
COUNTY OF _____ ~_,,_._~ ___ _
Swo./ro (or affirmed) and subscribed before me of Sworn4(or affirmed) and subscribed before me of _V_i, Ph-hysical Pre.wn~ __ Online Notarization __ VPii~ical Presence or __ Online Notarization
this ~day of ..>£.p., . 202f by this ~ay of .S-ert-, 202, by
~HN~t~c~hoe~f~'-f~-~&:J~ki~~~---------INMamerdit/Jtfofpersonema&k,·ngWPtJement. ame o person m~ statement. ~
Personally Known / OR Produced Identification__ Personally Known / OR Produced Identification __ _
Type of Identification Type of Identification
Produced,-;------,;---,,--Produced·,,------;.:-----,....---
CONWELL
Notary P1Jb!ic • ~tat, of Fiorid1
Commission No. -4-.l/~~h,,;C•omml,sio(6l!!»J,1•701
........ .'';./ y omm. ExplrnAUJ 21. lOl<
Sondtcl thtou1h Natlon,I Nottr, AsSI\.
(Signature of Notary
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