HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - Mackiw dF
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name.* Name:
Address: Address:
City: State: City: State:
zips* Phone.- Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY,* _Not Applicable
Name: Name:
Address: - Address:
City: C i ty:
Zip: Phone: � Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 Assoctation 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,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 j*obsite before the first i nspection. If you intend to obtain financing, consult
with lender or an attorney_before commencing.work or recording_your Notice of Commencement.'
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Non
signat re of o er/lessee/Contractor as agent for Owner Sig ature of ntractor/Lice n se Holder
STATE OF FLORIDA STATE OF FLORIDA�A ,,�
COUNTY OF �A'�LTI � COUNTY OF-
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization �Physical Presence or Online Notarization
thi day of .�(,Y�rt)�i�' ,�6�8-by this *%*day of Alit-4JC,�'9� ,2Q2fr by
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Name of person making statement. Name of person making statement.
Personally Known /� OR Produced Identification Personally Known�_OR.Produced Identification
Type of Identification Type' of Identification,-
Produced Produced
S1gtt.ature of N tary ubliAXState i re of N ary ub -St
Notary Public State of londa � �Y'�y_ �Notay Pubhe Slate of Florida �
Com fission No. O`er 0 � �SGalbpnna Jay ne Hall Com sion No. pia Jayne Hall �
My Commission GG 20 585 a: a My Commission GG 20758 �
P,.xpres 04/15I2022 ?a�o� Expires 04/15f2022 �
RE IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
[)ATE
RED IVED
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COMPLETED J J
ev_.5/6/20