HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE PAGE 2DESIGNER/ENGINEER:
Name:
Not Applicable MORTGAGE COMPANY:
Name:
Not Applicable
Address: Address:
City:
Zip: Pone
State: _ City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable BONDING COMPANY:
Name:
Not Applicable
Address: Address:
City: City:
Zip: Phone:
i
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 reppresentation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any alpplirable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 paying twice for
improvements toyour property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and postedgn the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an atorPSey before commencing work or recording your Notice of Commencement
ntroctor- or - Owner Builder as applicable
STATE OF FLO t ID A
COUNTY OF i(Lu
Sworn to (or affirtr ed) and subscribed before me of Physical Presence or _ Online Notarization
this\, daty of 1fL.1c 202Yby
C e—
Name of person makingstatement.
Personally Known OR Produced Identification
Type of Iden ' ion Produr,gd6,
Signature of Notary Public- S to
Commission No. 11 (Seal PublicTHERAate of r` Notary Public Slate E Flontla Commission
n GG ZOZ301 FofldedMyComm.ExpiresApr1,2022 through
National Notary Assn. REVIEWS
FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE
RECEIVED
DATE
COMPLETED
Rev
10/1Z/Z1