HomeMy WebLinkAboutBuilding permit app, pg 2_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: ________________ _ Name: _______________ _
Address: ______________ _ Address: _______________ _
City: -----= ______ State:
Zip: _____ Phone. ________ _
Oty: ____ =--______ .State:
Zip: ____ Phone: ________ _
FEE SIMPLE l1TlE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Address_: ______________ _ Name: ______________ _
Address: ______________ _
aty=-----------------Zip: ____ Phone: ________ _
City: _______________ _
Zip: ____ Phone: ________ _
OWNER/ CONTRAC10R AFFIDVIT: Applicalioi1 is hen!by made to obtain a permit to do the work and installation as indicated.
I certify that no work en illstallation has anm11euced prior to the issuance of a pennit.
St. Lucie~ makes no np-esentation that is &ranti!IR a permit will authorize the permit holder to build the subif1q structure
which conflicts with any af!l'!icabte !!omeowners Jwodation rules. bylaws or and covenants that n:,av restrict or prohibit such
structure. Please mnsultwith your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested ~ I do hereby agree that I will, in aH respects. perform the work
in acco,da.,ee with the approved plans, the Aorida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a lull concurrency review: room additions,
accessory structures, swimming pools, fences, wals, sisns, saeen rooms and accessory uses to another non-residential use
WARNING 10 OWNER: Yourfallure to Racord a Notice af CarMlencement may ,-,itln 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 before commencinl> work or reconlirur vnur Notice of Commencement.
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Signature of Owner/ lessee/Contractor as Al!el>t fur Owner
STATEOFR.ORIOA S\-. ~ COUN1YOF
Sworn :J. (or affinnedj and subscribed before me of ✓ Physical Presence or __ Online Notarization
this~dayof V,MJ'.llbtc .20jJ by
H.~J ~ ~
Name of person makingement.
PersonaHy Known ✓ OR Produced Identification --Type of Identification Produced A
/'/4.-ff~ 4. (~,1.1db
(Signature of Notary !'Iii! r.c-State .,.
Commissiori 'f'i'-~f••..... CM.!ISTINE ~fNWELL
,: ·• fFierie.!
' \~ rj;i Commkslon I GG 98'70·
·--~-.. ,./ My Comm. ExplresAut 2', :::
....... Bondl<I thrOIJlh Natlon1I NO\l', '·,, · . I
REVIEWS FRONT ZONING SUPERVISOR PlANS VEGETATION SEATURTlE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETEO
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