HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
BONDING COMPANY: X Not Applicable
FEE SIMPLE TITLE HOLDER: X 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 grantinga permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Associaion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 Counposted on the jobsite before the first inspect" off you intend to obtain financing, consult
with 1pnd'6rora attppneV before commencing work or rdin our Notice of Commencement.
Signatur f Owner/ Le e'Eq ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Martin
Saffirr�r,a� d su s-r'bed bef r me of X Physical Presence or Online Notarization
thiswoeday '20_
Michael O'Donnell
Name of person making statement.
Pero a y Known X OR Produced Identification
Typ f tification Prod
{Si natu e f Notar ub c State of FloridaI, Wynn Allen
Commissio No. (Seal) •• Comm.#GG366362
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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COMPLETED
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