HomeMy WebLinkAboutBUILDING PERMIT APP, UPDATED PG 2-missing notary signatureSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicabl e
Name: Name:
Address: Address:
City : State: --City: State : --Zip: Phone Zip : Phone:
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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 installa t ion as ind icate d .
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 ho lder to build the subject stru ct ure
which conflicts with any applicable Homeowners Association rules , bylaw s or and covenants that may restrict or proh i bit su ch
structure. Please consult with your Homeowners Association and rev iew your deed for any restrictions which may apply .
In considera t ion of the granting of this reque sted perm it, I do hereby agree that I wi ll, in all respects , perform the wo rk
i n 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,
acces sory struct ures, sw imming pools, fences , walls, signs , screen rooms and accessory uses to another non -re sidentia l 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 attorne before commencin work or recordin our Notice of Commencement.
Signatu re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID:i.3 d
COUNTY OF (Dv.l~
Swo T r,r(or affir~and sub ~ed before me of
thi s "'ba y of Me,;y,,~ , 20 ~ by
-~ Physical Presence or __ Online Notari zation
Name of person making statement.
---Perso.rally Known ~ OR Prbduced Identification
Type 'of Identification Produced _________ _
(Signa t ure of Notary Public-State of Florida) ------------,
Commi ssion No .
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
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FRONT
COUNTER
ZONING
REVIEW
EDlnl CARRERAS
NOTARY PUBLIC· STATE OF FLORIDA
COMMISSION# GG 181862
My Commission Expiras Fe~ruary 1, 2022
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW