HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 2SUPPLEMENTAL CONSTRtJCl"IONl:IEN LAW INRJftMAlJON:1
•· •.
. . .. ·.·· . .
" . ' ., ' •.
DESIGNER{ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable .
Name: Name:
Address: Address:
Crty: State: --Crty: State: --Zip: Phone Zip: Phone:
FEE SIMPLE TITl£ HOlDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Appffcatio11 is hereby made to obtain a permit to do the work and installation as indicated. I certify that no worlc or Installation has commenced prior to the issuance of a permit.
St. Lucie County makes no ~tation that is iuantin1< a perF!lit will authorize the permit holder to build the subject structure
which conflicts with any apJ>!lcable Homeowners 7'ssociation rules, bylaws or and covenants that l1)aY restrict or prohibit such
structure. Please consult with your Homeowners Association and rw,ew your deed for any resmctions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in aH 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: roorn additions,
accessory structures, swimming pools, fences, waHs, signs, saeen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Cammencement 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 commencino work or recordinl!: vour Notice of Commencement.
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORmA ~L. I 11r;,,
COUNTYOF ____ J\-'-~~'-=------✓ Physical Presence or __ Online Notarization Sworn to (or affirmed) and subscribed before me of
this U-ll--day of .:favtY4'j:J , 2022. by
~t~gAJma~ent.
Personally Known ✓ OR Produced Identification __
Type of Identification Produced. _________ _
(~#bl~ -
.. ,t!!_, ·•·····•.. CHRISTINE JOYCE CONWELL
Commission No. / • · l)Not1ry Pt.ibUc • Statt of flor1da
\°l~ ' CommllSIOI\ # GG 91-4701
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev
i ··~ / My Comm, Exptrts Aul 21, 201•
············..,,dtd throup N1tlon1I Notlry AISII. ,,.
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURilE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW