HomeMy WebLinkAboutBUILDING PERMIT APP (2)QI�STRtI��fIQ(�L�1)=N SAW INF�C�R6yI�4`P�raN
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Address:
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City:
Zip: Phone:
State:one
State; _
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 wont ano mscauaaon a� uw:ceLcv
I certify that no work or 1nstallatlon has commenced prior to the issuance of a permit.
St. Lucie County makesyno representation that is granting a permit will authorize the permit holder to build the subject structure
structure, Please consult with your Homeowners Association and review your deecovenants
f r any restrictions which mayrapply. such
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 recordsof
St,
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, on
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Signature of Contractor" or -Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF SE�TSS LUCIE
Swor18 dar ofrUk yrbedbefore Yeof X Physical Presenceor_OnlineNotarization
this _ y . 20 22 b
CHRISTOPHER LANGEL
Name of person making statement.
Personally Known �_ OR Produced Identification _
Type of Identification Produced
( nature of Notary Public -State OT Florida)
Commission No t 't('ti"- JUSTINAI.,HOPKINSCONNELLY
,��'q�'tgeal) �?t' �%a MY COMMISSION 800940662
EXPIRES; December 17, 2023
P,EfyOc'�` bonded Thru Notary Public UndeWtani
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1Lu/1Z/G1
Rev 1Lu/1Z/G1