HomeMy WebLinkAboutAPPLICATION Forward 1.11 • �'Ow• :1 •• Im
1 .
DE51 N'EitjENG1NEER* _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: mom, Name:
Address: Address:
City: State: City: State:
Zi p: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: - Address:
C ity: City:
Zi p: Phone: � Z i p: 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 subj ect structure
which is in conflict with anY applicable Home Owners Assocration rules,bylaws or and covenants that ma y 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, 1 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 jo site before the first inspection. If you intend to obtain financing, consult
with lender or an attorney,_before com.mencing__work or recording y Notice of Commencement,,'
Signat re of Ow er/Lessee/Contractor as Agent for Owner Sig ature of ntractor/License Holder
STATE OF
STATE OF FLORIDA COUNTY OFFLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physlcdl Presence or Online Notarization Physic al Presence or Online Notarization
this -„`day of�h��j1 _,�6�8-by this �"day of �1lSU`.�'1 ,�B�bY
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ZwO,2wi
Name of person making statement. Name of person making statement.
Personally Known � OR Produced identification Personally Known�_ORProduced Identification
Type of Identification Type of Identification;
Produced Produced
AA rA
Sig ature of N tart' ubli State i re of N ary. ub -St
�/����� ►it', Notary Public State of londa r7�� ds►�'�` �N�ot�y Pubhe State of Florida
Com fission No. �`� Stalbonna jaiy ne Halt Co m � sion No. � j F (�7i41a Jayne Hall
,►�. � My Commission GG ZO 585 v���,� My Commission GG 207 58
N►h
�xpres 04115/2022 ,o'P Expires 0415512022
RE IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
REC IVED
DA E
CONIPLETED
ev.!V 6/20—