HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SU PPLEM ENTAL CONSTRUCTION
DESIGNER/ENGINEER: \ Not Applicable
Name:
Address:
City:State:
Zip: _ Phone.
MORTGAGE COMPANY: XI\Iot Applicable
Name:
Address:
City:te:
7ip:
FEE SIMPLE TITLE HOLDER: $ot Applicable
Name:
Address:
City:
zip:Phone:
BONDING COMPANV' ;frvot Applicable
Name:
Address
City
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 subiect structure
which conflicts'with anv appl'icable Homeowners-Associalioh rules, bvlaws or and covenants that mav restrict or or6hibit suchstructure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
ln 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. lf you intend to obtain financing, consult
with lender or an before work or Notice of Commencement.
Signature of Lessee/Contractor as Agent for Owner
STATE OF FLORIDA <-,\ t -.
couNw oF >f- \^)u*,
Swornto (or affirmed).and subscribed before me of
$s 2l day of S€ftat€E€- , zo? by
-"-'HPhysical Presence or _ Online Notarization
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Name of person rnakir_(9ing statement.
Perso '%rroduced rdentifica
io. proar."a HECr 0A 0U
of Notary
Commission No.(Seal)ORLANDO VAZQUEZ
Notary Public - statg oJllgliaa
J;: Commission * GG 189841
itY Mv Comn. ExPires Feb 26,2022
Bonded through National Notary Assn'
DATE
COMPLETED