HomeMy WebLinkAboutpermit page 2, updatedDESIGNER ENGINEER; _NotApplicabe+
MORTGAGE GOMPANY; Not Applicable
Name:
Name:
Address:
Addreess:.
City: State;.
City: State:�
Zip: Phone:
Zip;. Ph,stil:e:
FEE SIMPLE TITLE HOLDERt _ NotApplicabie
BONDING COIyiPANYi. _ RotAppll oblp
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. Luce Count makes no represe t tionthat Is granting a .emit 111 authhorizothe ernilt holde to yyulld the.sub ect s, ruytur.e
is in t with Home Assoc�atfon bylaws coyenants.t� restrlci.
which contli any applica��e :dwners rues ordn at ay rpro'iblt.such
structure. Please consult.wlth your Home'Owners Assoclation and revlew:.youYdeed forahyrestrictlons,which may apply.
In consideration. of the, granting of this requested permlt,,Ido hereby. agree that ImIll,' n all respects„perform the work
In accordance with the approved plans,the Elorlda *Building -Codes and St, Lucile County Amendments,
The following building permit applicatlons•are exempt from undergoing a full concurrebey feVl6W:iroom addltlons;
accessory structures, swimming poois fehces; wails,•sians',"screetSroom's and accessary uis6.f6anoiher non-reside'ntlal use
WARNING TO OWNER: Your failure to: Record a Noffce of Cotnmencemehrmay,resulYln ppaying;twice for
Improvements to ,your property, A Notice of Commencement mtist:be:re'cordtbd In the°pp"ubilc records of St.
Lucle County and posted on the jobsite before: the 'first inspection, If you intend to obtain•fiha'ncing; consult
oranattorney commencin workor•recordi oOrNotice:of.Commencement,
�with —before
hllender
SI nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OFFLORIDA, ` � �(�a1(�)�If�pZQo2/
`�7"
COUNTY OF
ryl'
Sworn to (or affirmed) nd ubscribed before me of Physical Presence or Online Notarization
this _1.dayof� [-; 20.21 by
t J_.✓cc--vim_
r S �
Name of person making statement,
Personally Known OR Produced identlflcaflorL...
_ _
Ty ofidentiflratio Pri ced_•�
_
'CAITLIN RRIUL
pvu4c # HH 065595
MY COMMISSION
Signature ofNotary ubllc-State £F 7da
lThru Notary polalcUnder"are
Bonded
commission Not(seal) NotaPublloStateofflodds
Diana Gomez
v ay.080aa2
Explre4 ltl/01/2024
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