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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDESIGNER ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Applicable i Name: _Not Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is herebymade 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 CountyY makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in contlict 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 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 attorney before commencinjzwork or recording our Notice of Commencement. y Signature of Owner/ Lals .�de/CkWactor as Agent for Owner Signature of Contra /Nc&rfse Holder STATE OF FLO IOA STATE OF FLOP COUNTY OF 9 r)C COUNTY OF J C Sworn to (or affirmed) and subscribed before me `/- Sworn to (or affirmed) and subscribed before me �t+)/�j(I� ysical Presence or Online Notariz ion b4h sical Presence or Online Notarizat' this day of '� 2lj�y this2dayof_� 2o2�by t rt z t I Name of person making statement. 3 3 17 m Name of person making statemen .� n/ 332< o4no Personally Known OR Produced Identifi tf3�rL° c o Personally Known L OR Produced Identific ti 3 m _ Type of Identification > > ,Type of Identification Produced a kn coy Produced Sr o G7 ji 2 - L) AR0F: 9DFy (Signature of Notary Public- State of F rida o (Signature of Notary Public- State orida) in m ENO. jTO. Commission Noaf� (Seal) o m Commission No (Seal n"Vi o ! 1 i N � O REVIEWS FRONT ZONING i SUPERVISOR PLANS VEGETATION SEATURTtE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.