HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SUPPLEMENTAL CONstRUCilON UEN I.AW 1'4FORMATJOR;
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: -Not Applicable Name: ________________ _ Name: _______________ _
Address:·
Oty: __ -~--_-_ -_ -_--=-cc--~--_-_-_-_-_-_-~--_--,s=-ta_t_e_: ====--
Zip: _____ Phone. _________ _
Address: ______________ _
Oty: ___________ ~State: __
Zip: _____ Phone: _________ _
FEE SIMPI.E TITlE HOlDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: ________________ _ Name: ______________ _
Address: _______________ _ Address: _______________ _
City: -----=,-------------Zip: Phone: ---------------
City: _____________ _
Zip: _____ Phone: _________ _
OWNER/ CONTRACJOR AFFIDVIT: Application is hereby made to-a permit to do the wort and installation as indicated.
I certify that no work or instaRation has commenced prior to the issuance of a permit.
St. Lucie County makes no re~tation that is granting a per111it will authorize the permit holder to build the subjeet structure
which conflicts with any apJJ!K:able Homeowners :Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your HomecMN!rs A,,sotiatioii 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 appti<:.tions are exempt from unclefgomg a full coocurrency l1!1liew: room additions,
accessory structures, swimming pools. fences. -11s. signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: YOUI" tu1ure to Record a Notice Gf Couuencement 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 attomev before commencine: work or recordine: vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA St ~
COUNTYOF ______ ~~-----
%hysical Presence or __ Online ~ation swo:wor affirmed) and subscribed before me of
this . ay of Detwu::: , 20 .a.!_ by
M 1c~6d E: Bo~
Name of person making t.
Personally Known ✓ OR Produced Identification __
Ty~Produced
~0-~
(Signature of Notary +-Sta . . --
,-~'~,--· CHRIST/ME JOYCE CONWELL
Commission No. -· ~·-~f:\ Notary Public · Stat, of Florida
'.. [I_;/ Commission f GG 984701 ....... ~ ... ..ff!? M"f Comm. Explre-s Aw& 21, 2024
Bondtd thrOtJjh Nat!cr.al Not,ry Assn.
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