HomeMy WebLinkAboutDoyle Permit Application pg2SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: ' Not Applicable
Name:JAMES BUSHOUSE
Name:
Address:3300 NE 10TERR #24
Address:
City: POMPANOBEACH State: FL
City: State:
Zip: 33064 Phone 954-956-2203
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: XNot 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.
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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Co tr for as Agent for Owner Signature of Contractor/Li ens Ider
STATE OF f-ORfB€1'sI STATE OF FLORIDA
COUNTY OF {'� COUNTY OF \3I-UL,w+9-2D
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
AP ysical Prese , ce or Online Notarization Physical Presence or Online Notarization
S— day of 2021 by this �_ day of �ve�J E 2021 by
TARRY W. GETGEN
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known � OR Produced Identification
Type o l entification Type of Identification o��PYR'e�, ALANIRILMIK
Pro d S Produced * * Commission#GG289191
N„ t Expires May 5, 2023
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'TFOFF4oQ\ Bonded ThruBudget Notary servl
(Signature of Notary Public --State rida HdIA61t& (Signa ure of Notary Public- State of Florida )
VALERIA GARCIA _
Commission No. FNOTAkb�gLIC, STATE OF I L Smi Sion No�.� \4\ (Seal)
COMMISSION EXPIRES.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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