HomeMy WebLinkAboutBuilding Permit Application R. {
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOVR LENDER OR AN ORNEY BEFORE RECORDING YOU O,tICE OF COMMENCEMENT."
Sig ure of Ow er/Lessee%Contractor as Agent for Owner nature of ontractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Y_,,Qr) `� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this G k' clay of 20La_�y this-?0'day of - > it 20_Z_by
Name of person r4king statement. Name of person m' ing statement.
Personally Known OR Produced Identification Personally Known 'v_ FOR Produced Identification
Type of Identification e of Identification
Produced otary Public State of Florida P duced rNotary Public State of Florida
Kerri Lee Hite Kerri Lee Hite
My Commission GG 367402 r 1 8�Y'%
. My Commission GG 367402
artip Expires08/19/2023 y ` A 1ora� Expires08/19/2023
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.