HomeMy WebLinkAboutBuilding permit app, page 2DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: 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 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
f0WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOVR LENDER OR AN 6nORNEY BEFORE RECORDING YOU O#7CE OF COMMENCEMENT."
i
Sig ure of Ow er/ Lessee/Contractor as Agent for Owner
' nature of ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
this °"day of C)C:T 20 Z. ( by
The forgoing instrument was acknowledged before me
this 7,- day of 20 Lt by
l t?C,Lr_�\ y,er*C. S
G� ' i-
4 -eCr--5
Name of person making statement.
Name of person makingstattement.
Personally Known _LZOR Produced Identification
Personally Known L'_ stOR Produced Identification
Type of Identification
Type of Identification
Produced rw efY Public State of Florida
Kerri Lee Hite
MY Commission GG 367402n
orF+ Expires08/19/2023
Produced Notary Public State of Florida
hh (, Kerri Lee Hite
.z �.:r a My Commission GG 367402
Expires 08/1912023
(Signature of Notary Public- State o F on a
(Signature of Notary Public- State of Florida }
Commission No. qo Z (Seal)
Commission No. `3G)'to Z- (Seal)
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