HomeMy WebLinkAboutEveringham Permit page 2DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: Not Applicable '
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Address: Name:
Address:
City: State: City: State:
Zip: Phone
Zip: Phone:
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 installation as indicated.
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 holder to build the subject structure
which is in conflict with any applicable Home Owners Association 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, 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 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 your paying twice for
improvements
to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commend, u_ork or recording our Notice of Commenc -ment ..,,
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF_— �; -'
STATECOUNTY F ORID
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The forgoing instaiL ent was acknowledged 'before me
this day of
11
The forgoing instrument was acknowledged fore me
2ps� Y
this day of �} �`J 21
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of N ' ry Public- State Florida) %%it
Personally Known OR Produced Ident�i�lt c tiV12111'
(Signature of Nota Publi State of Florida
Personally Known OR ProducesType
of (dent' atign �.
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pe of identification <� .•� �iorrF: s
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Commission No. iseaO ®Q
G (kofimission No. 4r (Sear- e
WiG 341659
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